P3A090: Early Design and Testing of a Mobile Health Application and a Texting Program Supporting Breastfeeding for African-american/black Mothers

Background: Continuing racial inequities in breastfeeding (BF) rates create opportunities for new ways of supporting and promoting BF for African American/Black (AA/B) mothers. Smartphones may provide a way to reach, engage and support AA/B women who otherwise face barriers in accessing resources for BF. There is evidence that mobile health (m-Health) applications (apps) including text messaging and internet-based support can increase rates of postpartum exclusive BF [Quian, 2021], however very few m-Health apps are designed specifically for AA/B mothers. Structured interviews of AA/B women who did and did not BF revealed that “my own research” was a key factor influencing BF decisions [Furman, 2022], suggesting that a smartphone app with relevant content could engage women and provide breastfeeding support.

Methods: We created and curated informational and multimedia content, using plain language and AA/B representation, collaborating with a technology partner, Benten Technologies, to design the prototype app. Nine AA/B mothers participated in individual virtual “walk-throughs” of the app using a structured, “think aloud” interview with post-meeting survey using the System Usability Scale (SUS); six lay lactation providers (community health workers and certified lactation counselors) participated in a virtual focus group with app access, and one AA/B IBCLC (lactation consultant) reviewed the app content independently. We also created a text message library of BF-supportive messages for delivery at 28 weeks prenatally (weekly) through 70 days postpartum (daily to weekly). In a proof-of-concept texting trial, 20 expectant or just delivered AA/B mothers (13 prenatally; 7 less than 1 week postpartum) received text messages for a 4-week period. They assessed acceptability and utility of text messages via user experience surveys weekly and an Information Assessment Method (IAM) at trial completion.

Results: The app was well received, with positive comments about content relevance. Additional information was requested about milk expression and breast pumps, and “myth busting”. Participants also requested minor design changes for navigation buttons, features to log pumping, revisions to clarify category names, and supportive “pop-up” messages for a BF checklist. The mean SUS score (8/9 mothers reporting) was 83.75 (considered top 90-95%). In the texting proof-of-concept study, no participants opted out of texts, all but 1 received texts, all but 2 completed any user surveys, and all (9/20 reporting) gave positive IAM responses.

Conclusion: Our collaboration with an experienced technology partner and study team to evaluate a prototype m-Health app and informational text message program aimed at supporting BF and engaging AA/B mothers demonstrated project feasibility. In the pilot to follow, we will revise the app for re-evaluation, and will focus on individual text message content and relevance with all participants to begin prenatally ( < 35 weeks). Our ultimate goal is to conduct a clinical trial.

Supported by an Ohio Department of Health Breastfeeding Equity grant (BH23).