Effectiveness of WeChat for Improving Exclusive Breastfeeding in Huzhu County China: Randomized Controlled Trial

Exploring Pregnant Women's Perspectives in Developing a WeChat-Delivered Cognitive Behavioral Therapy for Insomnia: A Qualitative Study

STUDY OBJECTIVES

This study aims to explore the perception of a WeChat-delivered cognitive behavioral therapy for insomnia (CBT-I) to manage insomnia in pregnant women in mainland, China.

METHODS

A descriptive qualitative research design was used. Focus groups and individual interviews with semi-structured questions were conducted via a video conferencing platform with 29 Chinese pregnant women with insomnia symptoms during December 2023 to March 2024. Data were analyzed using content analysis.

RESULTS

Three themes and 10 subthemes were identified: (1) Appreciating sleep intervention for pregnancy insomnia; (2) Suggestions for intervention contents; (3) Recommendations on the format of WeChat articles. Participants appreciated the intervention's focus on pregnancy insomnia, recognizing its potential to address previously overlooked challenges. Participants indicated a willingness to engage with the program, although they raised concerns about an excessive focus on sleep-related issues. Suggestions for content improvement included using clear and plain language, incorporating scientific explanations to reinforce credibility, combining generalized content with personalized insomnia solutions, and including information relevant to the perinatal period. Participants also emphasized the need for family involvement to support them in managing insomnia. Regarding the format of WeChat articles, participants highlighted form is secondary to content helpfulness, while many suggested using engaging titles and visuals. Additionally, some prefer the short-form videos delivered via short video platforms over WeChat-delivered methods.

CONCLUSIONS

WeChat for delivering CBT-I for reducing insomnia symptoms was well received by the Chinese pregnant women and the identified main features may facilitate the design for future intervention studies.

Exploring nurse and patient perspectives on WeChat-based prenatal education in Chinese public hospitals: a qualitative inquiry

BACKGROUND

With the increasing digitization of healthcare, WeChat has emerged as a popular platform for delivering prenatal education in China. While studies have shown its potential benefits, few investigations systematically explore how nurses implement WeChat-based prenatal education and how pregnant women engage with these interventions within public hospital settings. Understanding both provider and patient perspectives is critical for developing equitable, effective digital maternal care.

METHODS

A qualitative exploratory design was employed in four public hospitals in Shanxi Province, China. Seventeen obstetric nurses and eight pregnant women participated in semi-structured interviews between March and August 2024. Data were analyzed using thematic analysis to identify commonalities and divergences between nurse-driven and patient-driven experiences.

RESULTS

Nurses perceived WeChat as extending their professional reach beyond physical clinic hours and enhancing patient education, aligning with the Technology Acceptance Model constructs of perceived usefulness and ease of use. However, organizational constraints, digital training gaps, and blurred work-life boundaries posed challenges. Pregnant women similarly recognized WeChat's convenience for quick clarifications and access to nurse-vetted information, yet wide variations in digital health literacy led to uneven engagement. Cultural factors, such as extended family involvement and preferences for in-person consultations, further influenced both nurse and patient usage patterns. Despite these challenges, participants converged on WeChat's value as a complementary platform that could reduce clinic visits, offer immediate reassurance, and bolster continuity of care.

CONCLUSION

WeChat-based prenatal education holds significant promise for improving maternal health outcomes by facilitating frequent, real-time communication between nurses and expectant mothers. Nonetheless, the findings underscore the need for hospital-level policies, structured training programs, and culturally sensitive strategies to address privacy concerns, manage workloads, and reduce digital disparities. An integrated approach that combines nurse acceptance and patient digital literacy is essential to fully harness WeChat's potential in public hospital contexts.

IMPLICATIONS

The study highlights practical steps for enhancing digital prenatal interventions, including standardized protocols for WeChat-based interactions, comprehensive nurse training in eHealth communication, and tailored support for pregnant women with limited digital skills. Such interventions can inform wider policymaking on telehealth and guide technology developers in creating user-friendly, secure digital platforms that optimize maternal care and reduce health inequities.

CLINICAL TRIAL NUMBER

Not applicable.

Effectiveness of a Web-Based Medication Education Course on Pregnant Women's Medication Information Literacy and Decision Self-Efficacy: Randomized Controlled Trial

BACKGROUND

Medication-related adverse events are common in pregnant women, and most are due to misunderstanding medication information. The identification of appropriate medication information sources requires adequate medical information literacy (MIL). It is important for pregnant women to comprehensively evaluate the risk of medication treatment, self-monitor their medication response, and actively participate in decision-making to reduce medication-related adverse events.

OBJECTIVE

This study aims to examine the effectiveness of a medication education course on a web-based platform in improving pregnant women's MIL and decision self-efficacy.

METHODS

A randomized controlled trial was conducted. Pregnant women were recruited from January to June 2021 in the Department of Obstetrics and Gynecology of a large hospital in a major city in central China. A total of 108 participants were randomly divided into a control group (CG), which received routine prenatal care from nurses and physicians, and an intervention group (IG), which received an additional 3-week web-based medication education course based on the theory of planned behavior as part of routine prenatal care. Participants completed a Medication Information Literacy Scale and a decision self-efficacy questionnaire at baseline, upon completion of the intervention, and at a 4-week follow-up. Generalized estimation equations (GEE) were used to analyze the main effect (time and grouping) and interaction effect (grouping×time) of the 2 outcomes. The CONSORT-EHEALTH (V 1.6.1) checklist was used to guide the reporting of this randomized controlled trial.

RESULTS

A total of 91 pregnant women (48 in the IG and 43 in the CG) completed the questionnaires at the 3 time points. The results of GEE indicated that there was no statistically significant difference in time×group interactions of MIL between the 2 groups (F2=3.12; P=.21). The results of the main effect analysis showed that there were statistically significant differences in MIL between the 2 groups at T1 and T2 (F1=17.79; P<.001). Moreover, the results of GEE indicated that there was a significant difference in decision self-efficacy regarding the time factor, grouping factor, and time×group interactions (F2=21.98; P<.001). The results of the simple effect analysis indicated a statistically significant difference in decision self-efficacy between the 2 groups at T1 (F1=36.29; P<.001) and T2 (F1=36.27; P<.001) compared to T0. Results showed that MIL and decision self-efficacy in the IG were found to be significantly higher than those in the CG (d=0.81; P<.001 and d=1.26; P<.001, respectively), and they remained significantly improved at the 4-week follow-up (d=0.59; P<.001 and d=1.27; P<.001, respectively).

CONCLUSIONS

Web-based medication education courses based on the theory of planned behavior can effectively improve pregnant women's MIL and decision self-efficacy, and they can be used as supplementary education during routine prenatal care.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100041817; https://www.chictr.org.cn/showproj.html?proj=66685.

Mobile applications for promoting and supporting breastfeeding: Systematic review and meta-analysis

Breastfeeding practices require improvement. We performed a systematic review of randomised controlled trials (RCTs) and analytic observational studies to assess effects of mobile applications (apps) aiming to support and promote breastfeeding targeting pregnant women, mothers of infants or their partners, on breastfeeding outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL and Association of Computing Machinery Digital Library from 1 July 2008 to 29 November 2022, with lack of coverage of the most recent period before publication date being a limitation of this review. We performed meta-analyses of findings from RCTs on primary outcomes, namely early breastfeeding initiation, exclusive and any breastfeeding rates. Joanna Briggs Institute tools were used for risk of bias assessment. Six RCTs, one quasi-experimental and two cohort studies, mainly from high-income countries, were included. Most studies focused on maternal app usage starting from pregnancy. One study targeted fathers as app-users. Population characteristics, such as parity or delivery mode, apps scope of content and applied active components varied between studies. Main methodological limitations of studies were baseline differences between groups and lack of blinding. Compared to controls, app usage tended to increase the odds of exclusive breastfeeding. This nonsignificant effect was most pronounced at 1-1.5 months (n = 1294, odds ratio 1.45 (95% Confidence Interval, CI 0.83, 2.54), with considerable heterogeneity between studies [I2 77%]), but less so at 3 and 6 months post-partum. The odds of early breastfeeding initiation, any breastfeeding at all time points were similar among groups. However, two cohort studies reported increased odds of exclusive and/or any breastfeeding at different time points. In conclusion, evidence is insufficient to show sustained beneficial effects of breastfeeding promotion and support through mobile apps on breastfeeding rates.

The need for educational intervention for breastfeeding women and the professional practice of midwives in France to promote breastfeeding: A joint explanatory study

In France, breastfeeding prevalence is high at birth, but its continuation remains low compared with other high-income countries, despite worldwide public health recommendations. Midwives offer parenting classes in an experimental manner without considering the importance of education in their interventions. The objectives of this study were to identify the teaching strategies and learning environments offered by midwives and their effect on women's perception of usefulness and their breastfeeding competence, to assess midwives' perception of usefulness and their pedagogical competencies. A comparative mixed study of 20 hospital midwives and 53 breastfeeding women (at 3 and 30 days postpartum) was conducted between January and August 2022 in two maternity units in France. Comparing the two periods, positive effects were found about breastfeeding women's level of knowledge: usefulness of learning theoretical (p=0.01) and practical (p=0.00) knowledge; and their breastfeeding management: signs of lactation (p=0.00), breast engorgement (p=0.04), and behavior (p=0.04). It positively reinforced the development of self-esteem (p=0.00) and commitment to breastfeeding (p=0.00). Midwives expressed strong motivation to use an appropriate teaching strategy and provide a supportive learning environment for women to improve their educational interventions (mean motivation score 7.7/10). The study results can promote research to examine educational interventions modeled according to the theories in education. Critical realism can be used to evaluate these interventions to elucidate how a program based on educational engineering can contribute to breastfeeding promotion and achieving the 2030 goals of WHO.

CLINICAL TRIAL REGISTRATION

The study was registered on the official website of ClinicalTrials.gov.

IDENTIFIER

ID NCT05271812.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

CLINICAL TRIALS NUMBER

NCT06256822.

The implementation of online and offline hybrid weight management approach for pregnant women based on the Fogg behavior model in Hainan, China: a pilot randomized controlled trial

OBJECTIVE

This study aimed at evaluating the effects of online and offline hybrid weight management approach based on the Fogg behavior model on total gestational weight gain and perinatal outcomes.

METHODS

Pregnant women in Hainan, the southernmost province of China, were recruited into a randomized controlled trial, which was designed to develop a WeChat platform for pregnancy weight management, and implement individualized and continuous pregnancy weight management services for pregnant women under the guidance of the Fogg behavior model. All pregnant women participating in the study were included in the full analysis set (FAS) for analysis. The pregnant women who completed the intervention and provided all outcome indicators were included in the per protocol set (PPS) for outcome evaluation.

RESULTS

Fifty-eight pregnant women were included in FAS analysis, and 52 pregnant women were finally included in PPS analysis. There was no statistically significant difference (P > 0.05) between the two groups at baseline. The gestational weight gain of the intervention group was significantly lower than that of the control group (P < 0.05). In the control group, the rate of appropriate weight gain during pregnancy was 48.26%, the rate of appropriate weight gain during pregnancy was 93.30% in the intervention group, with a statistically significant difference (P < 0.05). In the delivery outcomes, the cesarean section rate in the intervention group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The incidence of gestational diabetes mellitus and gestational hypertension in the intervention group was lower than those in the control group, and the differences were statistically significant (P < 0.05). The neonatal weight and incidence of macrosomia of the intervention group were lower than that of the control group, and the difference was statistically significant (P < 0.05).

CONCLUSIONS

This study combined the individualized and continuous pregnancy weight management of the online WeChat platform and offline consultation based on the Fogg behavior model, showing great potential in improving maternal and infant outcomes.

TRIAL REGISTRATION

The study was registered with www.chictr.org.cn/index.aspx , Chinese Clinical Trial Registry (ChiCTR2200066707, 2022-12-14, retrospectively registered).

Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial

Background

Parental health literacy is important to children's health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy.

Objective

This study aimed to determine the effects of a WeChat official account (WOA)-based intervention on parental health literacy of primary caregivers of children aged 0-3 years.

Methods

This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children's health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention's effect.

Results

After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children's health outcomes. Furthermore, despite slight subgroup differences in the intervention's effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors.

Conclusions

Using a WHO literacy model-based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes.

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement

Background

Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding.

Objectives

To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.

Design

Evidence syntheses with stakeholder engagement.

Review methods

Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops.

Results

We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence.

Limitations

There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics.

Conclusions

'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK.

Future work

Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies.

Study registration

This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Text messaging interventions for breastfeeding outcomes: A systematic review and meta-analysis

BACKGROUND

Given the health benefits of breastfeeding for infants and mothers, breastfeeding has become a significant public health issue. The global growth of mobile phone usage has created new options for breastfeeding promotion, including text messaging.

OBJECTIVE

We aimed to evaluate the efficacy of text messaging interventions on breastfeeding outcomes and to identify the efficacy moderators of such interventions.

METHODS

Ten electronic databases were searched from the inception of the databases to 5 July 2023. Studies were included if they used randomized controlled trials or quasi-experimental designs to evaluate the effect of text messaging interventions on breastfeeding outcomes. Two reviewers screened the included studies, assessed the risk of bias, and extracted the data. Pooled results were obtained by the random-effects model, and subgroup analyses were conducted on intervention characteristics to identify potential moderators. The protocol of this study was registered on PROSPERO (ID: CRD42022371311).

RESULTS

Sixteen studies were included. Text messaging interventions could improve the exclusive breastfeeding rate (at <3 months: OR = 2.04; 95 % CI: 1.60-2.60, P < 0.001; at 3-6 months: OR = 1.66; 95 % CI: 1.18-2.33, P = 0.004; at ≥6 months: OR = 2.13; 95 % CI: 1.47-3.08, P < 0.001), and the breastfeeding self-efficacy (SMD = 0.30, 95 % CI: 0.14-0.45, P < 0.001). Text messaging interventions that covered antenatal and postnatal periods, delivered weekly were most effective in improving the exclusive breastfeeding rate.

CONCLUSIONS

Text messaging interventions may improve breastfeeding practice compared with no or general health information. We suggest text messaging conducted from the pre- to postnatal periods in a weekly manner can effectively increase exclusive breastfeeding rates and breastfeeding self-efficacy. Further studies should investigate the relation between new theories (such as the health action process approach and the theory of message-framing) and efficacy of breastfeeding interventions, using text components.

The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials

Introduction

Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide.

Methods

A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315.

Results

This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers.

Conclusion

Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.

Effects of a mobile application on breastfeeding maintenance in the first 6 months after birth: Randomised controlled trial (COMLACT study)

PROBLEM

It is necessary to continue promoting breastfeeding rates.

BACKGROUND

Information and communication technologies have significantly impacted healthcare services and are transforming the sector. There is little evidence of the usefulness of mobile applications to support breastfeeding and increase its duration.

AIM

To assess whether mobile application-LactApp® (Barcelona, Spain)-usage compared with standard care increases the 6-month postpartum breastfeeding rate.

METHODS

A multicentre, randomised, controlled clinical trial of parallel groups was conducted. The study was conducted in four public hospitals in Spain from January 2022 to January 2023. 270 Women were randomly assigned to each parallel group. The women in the intervention group received free access to the mobile application LactApp®, which provides personalised and convenient support to women about BF. Women in the control group received standard care, which included individual counselling about the benefits of maintaining BF for the first 6 months of the baby's life.

FINDINGS

The rate of breastfeeding abandonment at 15 days was 6.4 % in the control group vs 0.0 % in the intervention group (p = 0.105). LactApp® usage did not increase the 6-month postpartum breastfeeding rate compared with standard care (CG = 41.6% vs. IG = 43.6 %; p = 0.826).

DISCUSSION

Further studies must explore how technologies can help improve long-term breastfeeding maintenance. The mobile app seems to reduce early weaning in the first 15 days slightly.

CONCLUSION

Mobile application usage did not increase the breastfeeding rate compared with standard practice but may reduce breastfeeding abandonment in the first 2 weeks postpartum.

Development of a mobile application -based breastfeeding program and evaluation of its effectiveness

BACKGROUND

Breastfeeding has many benefits for maternal and infant health. Mobile health interventions are increasingly used to increase breastfeeding initiation and support breastfeeding continuation.

PURPOSE

This study aimed to develop a mobile application-based breastfeeding program (MABBP) and to evaluate effectiveness.

DESIGN AND METHODS

This randomized controlled trial study was conducted with 73 mothers on the first postpartum day hospitalized in the postpartum service of a university hospital in Turkey. Mothers in the MABBP group (experimental group) were included in the mobile application-based breastfeeding training program on the first postpartum day. The Participant Information Form, the Infant Breastfeeding Assessment Tool (IBFAT), and the Breastfeeding Experience Scale (BES), Breastfeeding Follow-up Form, and Baby Physical Development Follow-up Form were administered. In the second follow-up, the Mobile Application Evaluation Form was used additionally to collect data from the MABBP group.

RESULTS

There was no significant difference between the postpartum first-day MABBP and control groups in the mean IBFAT scores. In the first and second follow-up, the rate of breastfeeding exclusively was higher and the rate of experiencing breastfeeding problems was lower in the MABBP group compared to the control group. While the mean BES score on the first postpartum day was significantly higher in the MABBP group compared to the control group, it was found to be significantly lower in the second follow-up.

CONCLUSION

It was determined that the MABBP contributed to the mothers' experiencing fewer breastfeeding problems and feeding the babies exclusively with breast milk at a higher rate.

PRACTICE IMPLICATIONS

This study suggests that pediatric nurses can support mothers during breastfeeding with the breastfeeding mobile application.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

RESEARCH AIM

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

METHOD

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

RESULT

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

CONCLUSION

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

Educational intervention for the maintenance of exclusive breastfeeding in adolescent mothers: A feasibility study

PURPOSE

The purpose of this study was to evaluate the feasibility of implementing the nursing intervention Breastfeeding Counseling (5244) in first-time adolescent mothers and its effect on the knowledge and maintenance of exclusive breastfeeding in the first 6 months of life.

METHODS

Randomized, controlled feasibility study with 166 first-time mothers between 14 and 19 years of age, from 20 to 30 weeks of gestation, assigned to an experimental group (nursing intervention: breastfeeding counseling) or a control group (usual education plus nursing intervention not related to breastfeeding). The rate of abandonment of exclusive breastfeeding and the level of knowledge about breastfeeding were evaluated.

FINDINGS

The inclusion was 91.7% (166/181), dropout during the intervention was 39.75% (n = 66), and loss in the follow-up was 8.43% (n = 14). Compliance with the intervention protocol was 100%. The pregnant women and family members were satisfied with the intervention and perceived the health benefits for the mothers and their children. Outcome measures in the experimental group did not reveal a significant effect on breastfeeding abandonment rates at 2, 4, and 6 months postpartum, but they did manage to improve and maintain the level of knowledge about breastfeeding.

CONCLUSIONS

It was found that it is feasible to implement the nursing intervention: "Breastfeeding counseling" in prenatal classes, achieving an increase in the level of knowledge about breastfeeding in adolescent mothers, but without a reduction in the rate of abandonment of breastfeeding. Nursing professionals need to know and address barriers to exclusive breastfeeding in adolescents.

IMPLICATIONS FOR NURSING PRACTICE

The nursing intervention "Breastfeeding counseling (5244)" and the outcome "Knowledge: Breastfeeding (1800)" supported the processes of education and knowledge assessment on breastfeeding in pregnant adolescents, which should be instituted in perinatal nursing care.

The effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding and movement behaviour of children aged 6-20 months in rural China: a cluster randomized controlled trial

Background

Appropriate infant feeding and movement behaviour (i.e. physical activity, sedentary behaviour, sleep) play an important role in children's healthy development during the first two years of life. The popular Chinese social media app 'WeChat' has become a potential data collection and health promotion tool. We aimed to evaluate the effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding practices and movement behaviour of children aged 6-20 months in rural China.

Methods

We conducted a two-armed cluster randomized control trial in Datong County, Qinghai Province, China. There were 106 clusters from 257 villages allocated (1:1) to two groups: the feeding group, which received a complementary feeding recommendations feedback report; the movement behaviour group, which received movement behaviour recommendations feedback report. The feeding group acted as a control for the movement behaviour group and vice versa. Children aged 6-20 months and their primary caregivers were invited to be participants. WeChat was used to collect the data on outcomes and to deliver the interventions. Participants received the interventions by filling out the WeChat self-assessment questionnaire and reading tailored feedback reports at baseline, at the first 1-month follow-up and at the second 2-month follow-up. Outcome measures included changes in the prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD); and the proportion of children who met physical activity time (PAT), outdoor time (OT) and screen time (ST) recommendation between the two groups at the two follow-ups. This study is registered at Chinese Clinical Trial Registry-ChiCTR2200062529.

Findings

Between September 28th and October 12th 2022, we recruited 1610 children in 106 clusters, of which 53 clusters (800 children) were randomized to the feeding group and 53 clusters (810 children) to the movement behaviour group. All caregivers of children completed questionnaires at three time points without loss to follow-up. From baseline to the second follow-up, the prevalence of MDD (OR: 1.62 [95% CI, 1.16-2.28; p = 0.0058]), MMF (OR: 1.45 [95% CI, 1.03-2.04; p = 0.032]) and MAD (OR: 1.51 [95% CI, 1.12-2.05; p = 0.0081]) in the feeding group were significantly higher than that in the movement behaviour group. The proportion of children who met PAT during the last 24 h at the second follow-up (OR: 2.22 [95% CI, 1.26-2.17; p < 0.0001]) and OT at the second follow-up (OR: 1.94 [95% CI, 1.49-2.54; p < 0.0001]) significantly improved in the movement behaviour group compared to the feeding group. Furthermore, ST in the movement behaviour group showed a significant increase only at the first follow-up (OR: 1.36 [95% CI, 1.02-1.82; p = 0.036]).

Interpretation

WeChat-based self-assessment with tailored feedback was an effective channel to deliver feeding and movement behaviour recommendations in rural China in our study. This approach can be applied to change feeding practices of caregivers of young children alongside routine child health care in rural China.

Funding

Capital Institute of Pediatrics.

Community-based intervention via WeChat official account to improve parental health literacy among primary caregivers of children aged 0 to 3 years: Protocol for a cluster randomized controlled trial

Background

Parental health literacy is an important determinant of children's health, especially during the critical window of early development in the first 3 years. As the information communication technology develops, health education via social media is widely used to deliver health information. However, few studies have explored the effect of intervention via social media on parental health literacy.

Objective

This study aims to determine whether a WeChat official account-based health intervention can improve parental health literacy of primary caregivers of children aged 0 to 3 years in Minhang District, Shanghai, China.

Methods

The cluster randomized controlled trial includes all 13 community health centers (CHCs) in Minhang District, Shanghai. We take each CHCs as a cluster in the randomization. The CHCs are randomly allocated to the intervention or the control group through random sequence generation. Ninety primary caregivers of children aged 0 to 2 years will be recruited from each CHC, 1170 in total. Caregivers in the intervention group will be provided with a series of video clips and online reading material links on scientific parenting via a WeChat account. Caregivers in the control group will receive printed educational materials with similar contents to the intervention group. All the participants will access routine child health care and be followed up for 9 months. Online assessment of health literacy will be conducted for both groups before and after the intervention. The primary outcome is the change in the total scores of parental health literacy using a validated instrument. The data of secondary outcomes, such as exclusive breastfeeding in the first 6 months, anthropometric measurements, and disease conditions, will be extracted from routine health care records. Generalized linear mixed model (GLMM) will be used for data analyses.

Discussion

Compared with traditional health education, health intervention via WeChat official account could be a feasible and effective solution to improve parental health literacy.

Trial registration

This trial is registered with the Chinese Clinical Trial Registry (ChiCTR): (#ChiCTR2000031711) on April 07, 2020.

Sequential interventions to maintain the safety and service provisions of human milk banking in India: keeping up with the call to action in response to the COVID-19 pandemic

BACKGROUND

WHO recommends donor milk as the next best choice if Mothers' own milk (MOM) is unavailable. At our milk bank, during the COVID 19 pandemic, we observed a steep decline in the collection of donor milk, while Pasteurised Donor human milk (PDHM) demand increased. This called for active intervention.

METHODS

We employed the quasi-experimental quality improvement initiative. During September 2020 (baseline period) the team members identified modifiable bottlenecks and suggested interventions (using WhatsApp to increase follow up, telehealth and digital tools) which were implemented in October 2020 and the impact was evaluated till March 2021. The SMART aim was "to meet the demand (estimated as 15,000 ml/month) of donor milk for adjoining 80-bedded NICU". Process measures were; daily amount of donor milk collected, pasteurized donor milk disbursed to NICU, number of donors and frequency of donations. The balancing measure was that the collection of donor milk should not undermine the provision of freshly expressed MOM for babies.

RESULTS

Collection of donor milk increased by 180% from baseline during the Intervention phase. This was sustained throughout the sustenance phase (November 2020 and March 2021) with an average monthly collection of 16,500 ml. Strikingly, the increased follow-up of mothers with emphasis on MOM decreased the NICU's donor milk requirement from 13,300 ml (baseline) to 12,500 ml (intervention) to 8,300 ml (sustenance). Monitoring of daily MOM used in the NICU revealed a 32% surge from 20,000 ml (baseline) to 27,000 ml (intervention) sustained at 25,000 ml per month.

CONCLUSION

By improving the provisions of human milk banks, near-exclusive human milk feeding can be ensured even during the pandemic time.

Support for healthy breastfeeding mothers with healthy term babies

BACKGROUND

There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.

OBJECTIVES

1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support).  3. To examine the effectiveness of the following intervention characteristics on breastfeeding support:      a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive);      b. intensity of support (i.e. number of postnatal contacts);      c. person delivering the intervention (e.g. healthcare professional, lay person);     d. to examine whether the impact of support varied between high- and low-and middle-income countries.

SEARCH METHODS

We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness.  The certainty of the evidence was assessed using the GRADE approach.

MAIN RESULTS

This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included.  Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding.  The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90).  'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points.  There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants.  We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment.   We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country.  It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited.  AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points.  For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.

Analysis of the Application Effect of Multidisciplinary Team Cooperation Model in Chronic Heart Failure under WeChat Platform

Methods

From April 2020 to May 2021, 56 patients with CHF who were discharged from the cardiology department of our hospital after treatment were randomly divided into two groups: experimental group (n = 28) and control group (n = 28). The control group was given conventional nursing measures and health education and discharge instructions, while the experimental group received collaborative multidisciplinary team nursing care based on the WeChat platform on the basis of the control group, all for 3 months. All enrolled patients underwent the Self-Care of Heart Failure Index Version 6.2 (SCHFI v6.2), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the 6-minute walking test (6MWT test). The SCHFI v6.2 and MLHFQ scores, 6 MWT test results, and readmission rates within 3 months were observed and compared between the two groups.

Results

There was no significant difference between the SCHFIv6.2 and MLHFQ scores of the two patients at admission and at discharge, and the scores of the experimental group were significantly higher than the scores of the control group at the end of 3 months after discharge. On the other hand, the SCHFIv6.2 and MLHFQ scores of the two groups were significantly higher at discharge compared to admission; the 6-minute walking distance of the experimental group was significantly higher than that of the control group at the end of 3 months. The readmission rate in the experimental group was significantly lower than that in the control group.

Conclusion

The multidisciplinary teamwork model based on the WeChat platform can significantly improve the self-care ability and quality of life of CHF patients and reduce the readmission rate.

The Effectiveness of Virtual Lactation Support: A Systematic Review and Meta-Analysis

BACKGROUND

The World Health Organization recommends lactation support to enhance the rates of exclusive breastfeeding. Access to in person lactation support may be limited due to scarcity of resources (e.g., healthcare professionals) and geography. Advances in technology have allowed lactation supports to be offered virtually through information and communication technologies (i.e., telephone, internet, and social media).

RESEARCH AIMS

To (1) critically review and (2) statistically analyze the effectiveness of virtual lactation support for postpartum mothers' exclusive breastfeeding for up to 6 months.

METHODS

A systematic review and meta-analysis were conducted using PRISMA guidelines. Studies were included if they were (a) randomized controlled trials, (b) with a virtual lactation support intervention during the postpartum period, (c) reported on exclusive breastfeeding outcomes. Two reviewers independently assessed the risk of bias and extracted data. The prevalence of exclusive breastfeeding in each group and the total number of participants randomized for each group were entered into random-effects meta-analyses to calculate a pooled relative risk (RR) at three different time points (1, 4, and 6 months). The sample size was 19 randomized control trials.

RESULTS

Of the 19 studies, 16 (84.2%) were included in the meta-analysis (n = 5,254). Virtual lactation support was found to be effective at increasing exclusive breastfeeding at 1 month (RR, 1.21; 95% CI [1.09, 1.35]; p < .001) and 6 months (RR, 1.87; 95% CI [1.30, 2.68]; p < .001).

CONCLUSION

In this meta-analysis of randomized controlled trials comparing virtual lactation support with other postnatal maternity care, virtual lactation support was associated with increasing exclusive breastfeeding rates at 1 month and 6 months postpartum.The study protocol was registered (CRD42021256433) with PROSPERO.

Comparison of the agreement between WeChat-based self-administered and interviewer-administered data on infant and young child feeding in China: A test-retest study

Background

Measuring infant and young child feeding (IYCF) indicators is important in evaluating child health programs and making evidence-based decisions. With Internet and new media rapidly developing, communication apps such as WeChat (the most popular mobile social media platform in China) are widely used and can potentially be used as an alternative way to collect infant and young child feeding information. This study compares data agreement between a WeChat-based self-administered and an interviewer-administered survey on infant and young child feeding information.

Methods

We recruited 297 mothers of children aged 6-23 months in Fenxi County, Shanxi Province, China. Using the Test-Retest method, we first collected data through a self-administered survey using a WeChat-based electronic questionnaire and asked 36 questions on breastfeeding and complementary feeding knowledge, practices, and information sources. We then conducted an interviewer-administered survey using the same questionnaire and compared the data agreement between the two survey methods during the same day. Cohen's kappa score (κ) and intraclass correlation coefficients (ICC) were used for data agreement analysis for all 36 questions and six key IYCF indicators. The McNemar test was used to identify differences between the two survey methods for the six key indicators.

Results

There was substantial or almost perfect agreement for 33 questions (κ/ICC>0.60), and slight or fair agreement for the other 3 questions (κ/ICC<0.40). Agreement of all six key IYCF indicators was substantial or almost perfect (κ = 0.78-0.94), while two indicators showed statistical differences between the two survey methods (P = 0.03 for “Minimum meal frequency” and P = 0.001 for “Minimum accepted diet”). Analysis of reasons for inconsistencies showed that 43.6% of all the inconsistencies were not caused by the self-administered survey method. The cost of the interviewer-administered survey was much higher than that of the self-administered survey: ¥45.9 (US$6.8) vs ¥19.7 (US$2.9) per questionnaire.

Conclusions

The WeChat-based self-administered method can be used for future data collection of infant and young child feeding information in China. Most of the questions and key indicators showed very good agreement without statistical differences between the two methods.

Breastfeeding education in Chinese hospitals: A cross-sectional study

BACKGROUND

Breastfeeding education plays a crucial role in improving breastfeeding outcomes and has been employed in many medical institutions across China.

OBJECTIVES

To describe the current situation of breastfeeding education provided by hospitals to women in China, and to identify relevant factors associated with the exclusive breastfeeding rate at hospital discharge and the early breastfeeding initiation rate.

DESIGN

A cross-sectional study design.

SETTINGS AND PARTICIPANTS

We used an online survey platform called WenjuanXing to collect data from 2985 hospitals in China.

METHODS

We designed a questionnaire to collect data. The Mann-Whitney U test and Pearson's chi-square test were used to identify the differences between the different types and levels of hospitals. Binary logistic regression analysis was used to analyze the factors associated with the exclusive breastfeeding rate at hospital discharge and the early breastfeeding initiation rate.

RESULTS

A total of 2941 hospitals were included in the data analysis. In 86% of hospitals midwives were providing breastfeeding education on weekdays during the daytime. Information on how to deal with mastitis (80.8%) and weaning methods (71.5%) was less commonly provided to women. The hospitals often conducted breastfeeding education through antenatal education sessions and bedside health education, while 34.2% of hospitals used smartphone applications. The obstacles to conducting breastfeeding education in hospitals were a lack of full-time staff dedicated to breastfeeding education (43.3%) and limited funds invested in breastfeeding education (42.5%). A lack of full-time staff dedicated to breastfeeding education (OR, 0.689; 95% CI, 0.498-0.953) and a lack of space (OR, 0.697; 95% CI, 0.487-0.997) were associated with the exclusive breastfeeding rate at hospital discharge. Furthermore, a lack of full-time staff dedicated to breastfeeding education (OR, 0.372; 95% CI, 0.235-0.589) was associated with the early breastfeeding initiation rate.

CONCLUSIONS

To improve breastfeeding outcomes, hospital managers and policymakers should increase the number of midwives and full-time staff who are dedicated to breastfeeding education, resolve the obstacles of limited funds and space for breastfeeding education, and explore more approaches to providing knowledge on breastfeeding to women and their families.

Social Media–Based Interventions for Health Behavior Change in Low- and Middle-Income Countries: Systematic Review

Background

Despite the wealth of evidence regarding effective health behavior change techniques using digital interventions to focus on residents of high-income countries, there is limited information of a similar nature for low- and middle-income countries.

Objective

The aim of this review is to identify and describe the available literature on effective social media–based behavior change interventions within low- and middle-income countries.

Methods

This systematic review was conducted in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, Embase, Elsevier, CINAHL, PsycInfo, and Global Index Medicus, and the final search was conducted on April 6, 2021. We excluded studies published before 2000 because of the subject matter. We included studies that evaluated interventions conducted at least partly on a social media platform.

Results

We identified 1832 studies, of which 108 (5.89%) passed title-abstract review and were evaluated by full-text review. In all, 30.6% (33/108) were included in the final analysis. Although 22 studies concluded that the social media intervention was effective, only 13 quantified the level of social media engagement, of which, few used theory (n=8) or a conceptual model (n=5) of behavior change.

Conclusions

We identified gaps in the settings of interventions, types and sectors of interventions, length of follow-up, evaluation techniques, use of theoretical and conceptual models, and discussions of the privacy implications of social media use.

Trial Registration

PROSPERO CRD42020223572; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223572

Knowledge Sharing for Maternal Health at a Public Hospital in South Africa

Purpose: This paper investigates knowledge sharing for maternal health in one of the major public referral hospitals in South Africa–the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Poor knowledge on maternal health continues to present a global challenge, particularly in developing countries where maternal mortality remains very high. Design/methodology/approach: A qualitative study and case study design were conducted to obtain an in-depth understanding of knowledge sharing for maternal health in one of the major public referral hospitals in South Africa. Convenience sampling of 35 pregnant women was undertaken. In-depth face-to-face interviews were employed to the point of saturation. Findings: The findings revealed elementary knowledge sharing for maternal health and several challenges to knowledge sharing. Limitations: This paper focuses on knowledge sharing at the antenatal care unit. Although effective knowledge sharing during antenatal phase may enhance post-natal care, it will have been beneficial to also understand the post-natal perspective of knowledge sharing. Furthermore, issues of representativeness may result from the use of convenience sampling. However, the purpose of this study is not to generalise the results but to provide an in-depth understanding of knowledge sharing for maternal health in a public hospital in South Africa and suggests a dynamic interactive strategy to enhance knowledge sharing that may effectively improve maternal health. Practical implication: Strategies for knowledge sharing for maternal health were established. The paper concluded that increasing knowledge sharing on safe motherhood practices would translate into safer pregnancy outcomes and would subsequently lead to lower maternal mortality. Knowledge sharing is critical in improving maternal health in a developing country like South Africa, where maternal deaths during pregnancy, childbirth and the puerperium remain a significant public health issue. Goal 3 of the 17 Sustainable Development Goals (SDGs) developed in 2015 seeks to promote good health and well-being and to reduce the global maternal mortality ratio (MMR) to fewer than 70 maternal deaths per 100,000 live births by 2030. Knowledge sharing is crucial in reducing the MMR. Originality/value: Studies conducted on knowledge sharing in the health sector have focused mainly on health professionals and the use of technology for mobile health. This paper adds to the body of knowledge-on-knowledge management and healthcare services, with specific focus on knowledge sharing and maternal care. Knowledge sharing for maternal health will reduce pregnancy, childbirth and motherhood-related health risks.

Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study

BACKGROUND

Maternal and child health (MCH)-related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes.

OBJECTIVE

This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes.

METHODS

A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks' gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women's self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis.

RESULTS

The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25).

CONCLUSIONS

Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings.

Predictors of Exclusive Breast Milk Failure Before Six Months: A Study on Exclusive Breastfeeding in the City of Bogor, West Java, Indonesia

BACKGROUND: Exclusive breastfeeding is the cornerstone of a child’s survival and health because it provides essential and irreplaceable nutrients for their growth and development. The coverage rate for exclusive breastfeeding for infants 0–6 months in West Java in 2017 was 55.4%, below the national figure of 61.33%. AIM: The purpose of this article is to identify the failure factors for exclusive breastfeeding. METHODS: The study began with a quasi-experimental period with a pre- and post-test group design approach through a health education process about exclusive breastfeeding in the third trimester of pregnancy, followed by a prospective study on breastfeeding practice in infants in the first 6 months of life. The analysis used was Chi-square analysis (χ2) and Paired t-test. Then, followed by a qualitative study to explore the supports and barriers to exclusive breastfeeding through in-depth interviews and carried out an analysis with modified Aronso’s qualitative analysis steps. The quantitative study sample is 50 people. The sample for the qualitative study was 15 people consisting of mothers with babies over 6-months-old, midwives, health staff. The study started from March 2017 to September 2018. RESULTS: The knowledge score of the intervention group increased significantly from 26.08 before the intervention to 31.78 after the intervention (p-value 0.000), with 3.52 more excellent than the control group. The attitude score of the intervention group rose significantly from 8.2 before the intervention to 13.16 after the intervention (p-value 0.000), with 3.12 more excellent than the control group. The intervention significantly affected exclusive breastfeeding behavior with a p-value of 0.047, but the behavior of exclusive breastfeeding was still 36%. The qualitative study findings contained support and obstacles in implementing exclusive breastfeeding in the city of Bogor. Supporting factors range from a support system in regional regulations and class programs for pregnant women to support for infrastructure. At the same time, obstacles include parenting patterns, individual factors, other internal and external influences. CONCLUSION: Health education can improve knowledge, attitudes and behavior of exclusive breastfeeding. There are still other predictors of the failure of exclusive breastfeeding before 6 months outside of health education.

Application of online case-based learning in the teaching of clinical anesthesia for residents during the COVID-19 epidemic

OBJECTIVE

COVID-19 prevention and control demand a reduction in crowd gathering, which has a significant impact on traditional teaching and offline case-based learning (CBL). In order to mitigate the impact of the COVID-19 outbreak on clinical teaching, we aimed to compare the effects of an online CBL with traditional teaching model on learning outcomes of anesthesia residents.

METHODS

Residents rotated in the Department of Anesthesiology in Beijing Tsinghua Changgung Hospital from January 2020 to February 2021 were included in Group W (n = 19), which implemented the W-CBL teaching model. The performance of residents was evaluated with theory test and 2 survey questionnaires (A and B) were conducted after 1 month of rotating. All 20 residents rotating in the Department of Anesthesiology at our hospital from January 2018 to December 2019 were included in Group C, which implemented the traditional teaching model. Their examination results were acquired through the teaching files and survey questionnaire (A) were administered through WeChat.

RESULTS

During the 1-month rotation, a total of 10 cases were discussed in Group W. The average score for theory test was higher in Group W than that in Group C (84.57 ± 4.87 vs. 79.35 ± 3.70, P = 0.001). The satisfaction rate was also in favor of Group W regarding to clinical thinking, communication skills, learning interest and self-learning ability (P < 0.05).

CONCLUSIONS

Online CBL based on WeChat platform is an effective and acceptable teaching strategy in comparison to lecture-based learning (LBL) among residents embarking on clinical anesthesia courses.

Smartphone-based counseling and support platform and the effect on postpartum lactation: a randomized controlled trial

BACKGROUND

Human milk lactation provides health benefits for both the mother and infant. Patients commonly report stopping breastfeeding sooner than they planned. Interventions with proper accessible counseling and support to the mother can potentially increase lactation rates and duration.

OBJECTIVE

This study aimed to investigate the impact of introducing a smartphone-based daily feedback and counseling platform between women after delivery and a multidisciplinary lactation support team on lactation rates and various maternal and neonatal outcomes. Counseling was provided via a specifically developed application from a multidisciplinary team (obstetricians, nurses, lactation counselors, and psychologist) in an attempt to assist and counsel to maintain lactation.

STUDY DESIGN

This was a prospective, single-center, randomized controlled trial. Women planning to lactate were recruited at postpartum day 1 and were randomized to (1) routine lactation counseling and support (control group) or (2) additional daily detailed counseling and feedback on lactation from the team via the application (App group). The primary outcome was partial or full lactation at 3 months after delivery. The secondary outcomes included lactation at additional time points up to 6 months after delivery. The study was adequately powered to detect a 15% difference in the primary outcome.

RESULTS

A total of 197 patients were recruited, 97 in the App group and 100 in the control group. The 2 groups did not differ in any background or delivery characteristics. The App group showed higher rates of lactation 6 weeks after delivery (96.9% vs 82.0%; P<.001) and 3 months after delivery (81.4% vs 69.0%; P=.049) than the control group. Patients in the App group reported excellent satisfaction from the use of the application and their overall postnatal care.

CONCLUSION

Our study has provided further information on the growing efficacy of technology platforms in obstetrical care. The introduction of a smartphone-based daily feedback and counseling platform between postpartum patients and a multidisciplinary lactation support team increased the lactation rates after delivery with excellent patient satisfaction.

Effect of School-Based Family Health Education via Social Media on Children's Myopia and Parents' Awareness: A Randomized Clinical Trial

Importance

Myopia is a common cause of vision loss, and its prevalence is increasing globally.

Objective

To evaluate the effects of school-based family health education via WeChat in raising parents' awareness of myopia prevention and behavior and in controlling the development of myopia in children.

Design, Setting, and Participants

A single-masked cluster randomized clinical trial of children was conducted from October 1, 2018, to December 31, 2020, among grade 1 students from 12 primary schools in Guangzhou, China. The 12 primary schools were randomly selected in 2 districts and randomized to the intervention and control groups. All grade 1 students were invited to participate, and 688 students were included in the intervention group and 752 in the control group.

Interventions

Weekly health education via the social media platform WeChat was provided to the parents in the intervention group.

Main Outcomes and Measures

Data include results of eye examinations of children and questionnaires completed by parents. The primary outcome was the 2-year cumulative incidence rate of myopia. Myopia was defined as a spherical equivalent (SE) refractive error (sphere of +0.5 cylinder) of at least -0.50 diopters (D). The secondary outcomes were the 2-year changes in the axis length and SE refraction, parental awareness, children's screen time, outdoor activities, and learning tools during COVID-19.

Results

Among the 1525 children included at baseline (835 boys [54.8%]; mean [SD] age, 6.3 [0.5] years), 1244 competed the final assessment; the 2-year cumulative incidence rate of myopia was 106 of 544 (19.5%) in the intervention group and 171 of 700 (24.4%) in the control group (difference, 4.9% [95% CI, 0.3%-9.5%]; P = .04). The mean myopic shift in SE refraction in the intervention group (-0.82 D) was lower than that in the control group (-0.96 D; difference, -0.14 [95% CI, -0.22 to -0.06] D; P < .001). No difference in change in axial length was detected (difference, 0.02 [95% CI, -0.06 to 0.09] mm; P = .70).

Conclusions and Relevance

School-based weekly family health education via WeChat resulted in a small decrease in the 2-year cumulative incidence rate of myopia with a difference in SE of less than 0.25 D not accompanied by any axial length differences. Whether these findings extrapolate elsewhere in the world or are clinically relevant in the short or long term remain to be determined.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR1900022236.

Effectiveness of a smartphone-based educational intervention to improve breastfeeding

Background

Exclusive breastfeeding (EBF) is essential during the first six months of life and confers countless benefits to mothers and infants. This study aimed to assess the effectiveness of a smartphone-based educational intervention to improve new mothers’ breastfeeding for infants younger than six months of age in Urmia, Iran.

Methods

A randomized controlled trial study was conducted from January to December 2019 with 40 new mothers and their first child aged < 3 months, assigned to the intervention (mobile app education + routine care) and control groups (routine care). The mean age of infants was 1.25 and 0.98 months for each group consequently. The designed app content categorized according to seven sections (the importance of breastfeeding, behavioral methods, complementary feeding and EBF, pumping and manual expression, managing common breast-related and breastfeeding problems, breastfeeding tips in special situations, and common queries) for educating the required knowledge to nursing mothers.

Results

Forty mothers were assessed for primary outcomes in each group. At three months, the mothers’ knowledge, attitude, and practice (KAP) had meaningful differences in the intervention group compared to the control group. In the intervention group, the degree of changes in knowledge and attitude were 5.67 ± 0.94 and 8.75 ± 1.37 respectively more than the control group (p < 0.001, p < 0.001). However, this amount for the practice score was 0.8 ± 0.49 which is considered to be marginally significant (p = 0.063). During the study, the mothers’ breastfeeding self-efficacy showed significant progress in favor of the intervention group. The score enhancement was 26.85 ± 7.13 for the intervention group and only 0.40 ± 5.17 for the control group that was confirmed to be significant (p < 0.001).

Conclusion

The smartphone-based app for educating new mothers on breastfeeding had a significantly positive effect on breastfeeding self-efficacy and maternal KAP. In future studies, the intervention can be tested in both prenatal and postpartum periods.

Middle-aged and elderly users' continuous usage intention of health maintenance-oriented WeChat official accounts: empirical study based on a hybrid model in China

Background

Although middle-aged and elderly users are the main group targeted by health maintenance-oriented WeChat official accounts (HM-WOAs), few studies have explored the relationship of these accounts and their users. Exploring the factors that influence the continuous adoption of WOAs is helpful to strengthen the health education of middle-aged and elderly individuals.

Objective

We developed a new theoretical model and explored the factors that influence middle-aged and elderly individuals' continuous usage intention for HM-WOA. Performance expectancy mediated the effects of the model in explaining continuous usage intention and introduced health literacy into the model.

Methods

We established a hybrid theoretical model on the basis of the unified theory of acceptance and use of technology 2 model (UTAUT2), the health belief model (BHM), protection motivation theory (PMT), and health literacy. We collected valid responses from 396 middle-aged and elderly users aged ≥ 45 years in China. To verify our hypotheses, we analyzed the data using structural equation modeling.

Results

Performance expectancy (β = 0.383, P < 0.001), hedonic motivation (β = 0.502, P < 0.001), social influence (β = 0.134, P = 0.049), and threat appraisal (β = 0.136, P < 0.001) positively influenced middle-aged and elderly users' continuous usage intention. Perceived health threat (β =  − 0.065, P = 0.053) did not have a significant effect on continuous usage intention. Both threat appraisal (β = 0.579, P < 0.001) and health literacy (β = 0.579, P < 0.001) positively affected performance expectancy. Threat appraisal indirectly affected continuous usage intention through performance expectancy mediation.

Conclusions

Our new theoretical model is useful for understanding middle-aged and elderly users' continuous usage intention for HM-WOA. Performance expectancy plays a mediation role between threat appraisal and continuous usage intention, and health literacy positively affects performance expectancy.

Trends in complementary feeding practices and caregivers' feeding knowledge among children aged 6-23 months: Repeated cross-sectional surveys in rural Qinghai China 2012-18

Background

Appropriate infant and young child feeding is the basis for child survival, growth and development. The aim of this study was to investigate trends in complementary feeding practices and caregivers’ feeding knowledge among children from 2012 to 2018 in Huzhu County, Qinghai Province, China.

Methods

This study took place during and after a controlled interventional evaluation trial in Qinghai Province, China, which aimed to evaluate the effectiveness of community-based nutrient-dense complementary food supplements (YingYangBao) combined with dietary counseling on improving 6-23 month-old children's health status. We conducted four representative cross-sectional surveys on caregivers of children aged 6-23 months in Huzhu County, Qinghai Province, China (baseline survey for the trial (N = 1804) in August 2012, end-line survey for the trial (N = 2186) in August 2014, follow-up survey 1 (N = 496) in January 2016, and follow-up survey 2 (N = 754) in July 2018). In all surveys we used the same questionnaire to collect household information, infant feeding practices and caregivers’ feeding knowledge.

Results

During the trial period (2012-2014), the proportion of children aged 6-8 months that introduced (semi-) solid food increased from 86.1% to 96.3% (P < 0.0001), however, there was a downward trend from 2014 to 2018 (P = 0.0014 for trend). The prevalence of minimum dietary diversity also increased from 51.4% at 2012 baseline survey to 57.5% at 2014 endline survey (P = 0.0004), but the upward trend did not maintain from 2014 to 2018 (P = 0.7863 for trend). The minimum dietary frequency, the minimum acceptable diet, and continued breastfeeding at one year were nearly unchanged from 2012 to 2018 (P = 0.9529, P = 0.7602 and P = 0.6013 for trend, respectively), remaining around 30%, 10% and 20% respectively in the four surveys. Caregivers’ feeding knowledge on the duration of exclusive breastfeeding and introduction of semi or solid foods at 6-8 months increased from 2012 to 2018 (18.6% to 39.5%, 43.2% to 64.3%, respectively).

Conclusion

This study showed that the sustainability of community-based YYB and dietary counseling program was suboptimal. We suggest that multiple information delivery channels such as smartphones and the Internet should be explored as a supplement to existing channels for delivering counseling information.

Trial registration

ChiCTRPRC12002444.

Feasibility of using WeChat to improve infant and young child feeding in rural areas in China: A mixed quantitative and qualitative study

BACKGROUND

Appropriate infant and young child feeding practices are the basis for child nutrition. In China, WeChat is gradually changing the channels through which people receive information. The paper aims to explore the feasibility of using WeChat to improve infant and young child feeding in rural China.

METHODS

A mixed-methods study was carried out in Huzhu County, Qinghai province, China. We conducted two cross-sectional surveys with children aged 6-23 months and their caregivers in 2012 (N = 1804) and 2018 (N = 754), respectively. Quantitative data were collected on feeding knowledge and practices, caregiver's use of smartphones and WeChat. Qualitative data were from 33 semi-structured interviews with pregnant women and mothers. In addition, we developed a WeChat feeding health education platform and asked women about their experiences with using it.

RESULTS

In both cross-sectional surveys, less than 10% of caregivers knew that breastfeeding can be continued up to two years, less than 50% knew the accurate duration of exclusive breastfeeding, and only around 20% knew meat can be given to children from the age of 6-8 months. Similarly, the feeding practices were suboptimal and most key infant feeding practices did not change over the years. Only around 30% of caregivers ever received feeding information during pregnancy or after delivery in both surveys. Around 50% of caregivers received information from their relatives and friends, followed by 30% from health facilities and communities. More than 80% of mothers were currently using both a smartphone and the WeChat app, and 75.4% of them were willing to receive feeding information from WeChat official accounts. The WeChat feeding health education platform developed by our study team was generally well accepted by women.

CONCLUSIONS

There was an absence of accurate information sources on infant feeding and child nutrition. WeChat could be a potential way to deliver infant feeding recommendations to pregnant women and mothers in rural China.

TRIAL REGISTRATION

ChiCTR-PRC-11001446 (The controlled intervention trial for complementary food supplements "Yingyangbao"); ChiCTR1800017364 (the randomized controlled trial for WeChat).