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Web-based sources of health information are widely used by parents to support healthy parenting and aid in decision making about their infants’ health. Although fraught with challenges such as misinformation, if used appropriately, web-based resources can improve access to health education and promote healthy choices. How Indigenous mothers use web-based information to support their parenting and infants’ health has not yet been investigated; however, web-based modalities may be important methods for mitigating the reduced access to health care and negative health care interactions that many Indigenous people are known to experience.
This study aims to understand the experience of Indigenous mothers who use web-based information to support the health of their infants.
This interpretive description qualitative study used semistructured interviews and a discussion group to understand how Indigenous mothers living in Hamilton, Ontario and caring for an infant aged <2 years experienced meeting the health needs of their infants. The data presented reflect their experiences of using web-based sources of health information to support their infants’ health. The Two-Eyed Seeing approach was applied to the study design, which ensured that both western and Indigenous worldviews were considered throughout.
A total of 19 Indigenous mothers participated in this study. The resulting 4 themes included distrusting information, staying anonymous, using visual information to support decision making, and accessing a world of experiences. Although fewer Indigenous mothers used web-based sources of information compared to mothers in the general population in other studies, tailoring web-based modalities to meet the unique needs of Indigenous mothers is an important opportunity for supporting the health and wellness of both mothers and infants.
Web-based information sources are commonly used among parents, and ever-evolving web-based technologies make this information increasingly available and accessible. Tailoring web-based modalities to meet the unique preferences and needs of Indigenous mothers is an important method for improving their access to reliable and accurate health care information, thereby supporting healthy parenting and promoting infant health.
The internet is widely used for various purposes around the world, including seeking health information. It has become so important to everyday life that some argue that access is a human right, contributing to political activism and freedom of speech [
Individuals, including parents, commonly use the internet and its products to seek information pertaining to their health and to support their health-related decision making. New and expecting parents, who have grown up with access to the internet, are the most frequent users of this medium for this purpose—seeking health-related information for themselves and their infants [
However, using the internet to search for health-related information is not without challenges. In studies investigating parental use of the internet to meet their health-related informational needs, parents were commonly unable to find the information they were seeking and could not discern high-quality information from low-quality information and desired reliable web-based sources to be made available by health care providers involved in their care and the care of their children [
Indigenous mothers represent a subset of parents who are known to face unique challenges in accessing health care and health information because of experiences of racism, discrimination, and social inequity resulting from racist policies that disproportionately burden Indigenous people, particularly women [
The data presented here describe how Indigenous mothers living in an urban city in Ontario, Canada use the internet, web-based apps, and social media to support the health of their infants. Indigenous people in Canada are recognized by the Constitution as First Nation, Métis, and Inuit groups, and within each group, there are numerous distinct communities with diverse cultures, languages, and traditions [
This study used a qualitative methodology, namely, interpretive description [
Participant mothers were recruited from local Indigenous organizations, including the local friendship center and women’s center, among others, through word of mouth and flyers posted at local health services. Mothers were included if they self-identified as Indigenous (First Nations, Métis, and Inuit), lived in Hamilton, Ontario and were caring for an infant aged <2 years. Data collection and analysis occurred simultaneously, and recruitment continued until conceptual redundancy was achieved and data were sufficiently detailed to answer the research question [
Data were collected through semistructured interviews, which lasted approximately 60-90 minutes with each participant mother and the first author at a location of convenience for the mother. All mothers were offered the presence of a research assistant, but only one mother requested this. All mothers spoke English as their first language. Interview questions were developed using
An iterative thematic analysis of the data was conducted by the lead researcher. Transcripts were read and reread and then coded according to the techniques described by Saldana [
The understanding of how Indigenous mothers in Hamilton, Ontario use web-based resources to meet the health needs of their infants is informed by interviews with 19 mothers. The demographic details are presented in
Briefly, 15 mothers were identified as First Nations, 2 as Métis, and 2 were unsure of their specific Indigenous heritage, as is not uncommon for Indigenous people, due to the lasting impacts of colonization, forced assimilation, and resulting loss of identity and cultural ties. The mean age of participants was 28 years (SD 5.82 years), and nearly one-third were first-time mothers. When asked whether they used the internet or other web-based sources to answer health-related questions regarding their infants, mothers reported solely using Google as their internet search engine and Facebook as their primary social media platform. No other search engines or social media platforms were mentioned by the mothers. Within the group of 19 mothers, 10 (53%) reported using Google, 4 (21%) reported using a health-related app, 5 (26%) used Facebook, and 6 (32%) did not use the internet in any form to address their informational needs regarding their infants’ health. Of the 6 (32%) mothers who used multiple internet sources, 2 (11%) used both Google and Facebook and 4 (21%) used both Google and apps, but none used all 3 types of internet sources (Google, apps, and Facebook).
When asked about the reasons for using various types of web-based resources, mothers reported using Google to search for infant norms (developmental milestones, normal temperature, normal behavior, and sleep patterns), how to care for common illnesses (especially rashes and fevers), signs and symptoms of infections, when to take the infant to see a doctor, and baby food recipes. Mothers reported using Facebook to peruse mom-to-mom blogs, share issues with other peers, and find examples of similar experiences related to infant health. Parenting apps were used to discover infant developmental milestones, especially weekly updates on developmental changes and stages, to answer questions about normal infant health issues, guidelines for when to start feeding solids, meal planning strategies for infants, and baby food recipes.
Data analysis of mothers’ experiences of using web-based resources to meet their informational needs pertaining to their infants’ health resulted in 4 main themes: (1) distrusting information, (2) staying anonymous, (3) using visual information to support decision making, and (4) accessing a world of experiences. The following section describes these themes in more detail. Supporting quotations from these themes can be found in
Demographic information: participant mothers.
Characteristic | Participants (n=19), n (%) | Comparison with First Nations data in Hamilton, n (%)a | |||
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<25 years | 5 (26.3) | —b | ||
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26-30 years | 8 (42.1) | — | ||
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>31 years | 6 (31.6) | — | ||
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0 | 0 (0) | 200 (36) | ||
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1-2 | 12 (63.2) | 200 (36) | ||
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3 | 2 (10.5) | 83 (15) | ||
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≥4 | 5 (26.3) | 72 (13) | ||
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Less than high school | 9 (47.4) | 316 (57) | ||
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Completed only high school | 3 (15.8) | 111 (20) | ||
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Some college or university | 7 (36.8) | 128 (23) | ||
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First Nations | 15 (78.9) | 9695 (67.1) | ||
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Métis | 2 (10.5) | 3960 (27.4) | ||
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Inuit | 0 (0) | 165 (1.1) | ||
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Unknown (not sure if First Nations, Métis, or Inuit) | 2 (10.5) | — | ||
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Family physician | 17 (89.5) | — | ||
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Pediatrician | 1 (5.3) | — | ||
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None | 1 (5.3) | — |
aNumber of children (% of family).
bDemographic data are not available for Indigenous people within the city of Hamilton.
cn=555; data obtained from Smylie et al [
dn=13,820; data obtained from Statistics Canada [
“Well I use the internet when he’s sick...search up his symptoms and just see. I try not to do that too much because sometimes some crazy things pop up and then I get scared.” [First Nations mother of two, aged 26 years]
“I look up on the Internet and some of the stuff that comes up, it’s like, I didn’t think you were allowed to use that kind of stuff on kids! And I’m like, no, I would rather go to the doctors and get her looked at. Sometimes when you read stuff on the internet, it is not always accurate.” [First Nations mother of five, aged 27 years]
“Every time you Google something it is always going to show up cancer.” [First Nations mother of two, aged 21 years]
“Well obviously, I question them. I know I shouldn’t be on doctor Google because obviously there is conflicting information out there.” [First Nations mother of two, aged 35 years]
“If you were to type in something like an ear infection, they will give you so many different options. Some of them say the same thing and some will say other things. Like I don’t know which one is going to be better for her or I don’t know how bad it is. I don’t always trust it.” [First Nations mother of three, aged 32 years]
“They do have like mom groups [on Facebook]. I don’t ask for other people’s opinions. They ask questions...like when something is wrong with their kid or something, they’ll say ‘is this normal’? and then other moms give their opinions and then I just go over it. I don’t really talk.” [First Nations mother of four, aged 21 years]
“Like mom-to-mom groups. I read. I don’t want to post in it because then all of a sudden you’re the center of the post and they never stop commenting. It will be a year later and someone is still commenting.” [First Nations mother of two, aged 21 years]
“Some moms will ask about their child and post a picture, and say if it is like a rash or say if they got chicken pox and they don’t know what it is. They will be like what is this? They post on there and other people will comment on what they think it is. But I thought [my son’s rash] was actually just a rash that he developed because he was sick. Then it was actually hives which when we went to the doctors she told me it was hives. An allergic reaction to something.” [First Nations mother of two, aged 21 years]
“Like they will post pictures of a rash on their kid, and be like, ‘I have a doctor’s appointment later but I am just looking for advice like if anyone else’s child has ever had this?’ What do you think it looks like? Things like that.” [First Nations mother of two, aged 26 years]
“I kind of just read Mom blogs. They make me feel a little bit better that there are other moms out there.” [First Nations mother of two, aged 35 years]
“Say your son has a rash, and you’re like, ‘There is this purplish-red rash, how do I get rid of it or what do I do?’ And [you get] fifteen answers from every mom who seems to be going through the exact same thing as you.” [Métis mother of one, aged 22 years]
“What kind of laundry detergent is safest for my son’s skin? There is someone else out there in the world, whose son has the same skin as your baby or goes through the same thing as your baby.” [Métis mother of one, aged 22 years]
“You are looking at ten different answers and there is one answer that appeals to you. Especially with your type of parenting style. There is someone who parents their children similar to you, right?” [Métis mother of one, aged 22 years]
Although most mothers used web-based sources of information to answer questions they had related to their infant’s health, development, and well-being, they also struggled to trust the information they found on the web. Mothers shared the impressions that the information was often inaccurate and did not align with other health information they had received from other, more trusted sources such as health care providers. A common complaint about using Google was that symptoms of illness were commonly associated with symptoms of cancer, which scared mothers and made them anxious. Mothers shared their struggles with navigating large amounts of information and the ways they had developed to assist them in choosing the information that they could use to make decisions. Some mothers reported reading numerous answers and choosing to believe or act on the advice that they found to be most frequent and consistent with their existing knowledge of the issue. Another mother went with her
Mothers required the ability to use web-based resources with complete anonymity. Even those who used Facebook to access parenting discussion forums chose not to engage with other mothers by replying to posts or posting their own. Instead, they chose only to read other mothers’ posts and apply relevant content to their own decision making and parenting experiences. One mother expressed her frustration at being constantly notified of new posts to her thread if she initiated a discussion in a mom-to-mom forum. Rather than having these notifications persist, she chose not to post at all.
The unique ability to share and view pictures was one of the most common reasons for mothers to use web-based resources, particularly apps and Facebook discussion forums. Although Google was used to look up pictures of specific symptoms or known illnesses, apps provided pictures of developmental stages and common newborn ailments or caregiving techniques, such as providing an infant with medicine. The use of pictures assisted mothers in interpreting health information that may have otherwise been complex and technical.
Facebook discussion forums were particularly important as they allowed mothers to post pictures of their infants’ symptoms and to seek advice from thousands of other mothers worldwide. The most frequent symptom that participant mothers spoke about was their infants’ rashes. These common newborn ailments were often confusing to mothers who wanted to understand the cause and source of the rashes and whether their infants’ rashes warranted seeing a physician. The participants used these forums to find pictures of symptoms that were similar to those of their own infants, as they did not post their own pictures. With hundreds or thousands of mothers subscribing to each forum, mothers did not find it difficult to find pictures and descriptions similar to the issues they and their infants were experiencing. However, this type of self-diagnosis is problematic. One mother shared her experience of using such a forum to determine that her infant had a rash associated with an illness. However, when she visited her physician, she was surprised to discover that the rash had been caused by an allergic reaction. These types of self-diagnosis errors can be dangerous for infants if mothers do not seek advice from a health provider, instead choosing to assume that their understanding of web-based resources is correct.
Finally, web-based resources, particularly Facebook discussion forums, provided mothers with access to thousands of mothers from across the world. Participant mothers shared that they had no difficulties finding mothers with similar questions, experiences, or dilemmas. This helped to normalize their experiences, boost their parenting confidence, and lessen their stress and anxiety by reassuring them that they and their infants were like others, even if those in their immediate social network were dissimilar. Although the participant mothers did not interact with other mothers on discussion forums, these forums formed a sort of web- and app-based social network, where mothers found a place in which they felt a sense of belonging and similarity with other mothers and where they felt secure in their ability to control their information and interactions through the anonymity provided by the sites.
In summary, the use of web-based sources of information for parenting and newborn health was common among participant mothers. These sources of information were not always reliable, and mothers struggled to determine which information to trust and act on among a sea of suggestions and advice from websites, apps, and Facebook discussion forums. The ability to anonymously peruse information was extremely important, as it facilitated mothers controlling their interactions and information-sharing with others. The use of pictures and other visual information assisted mothers in interpreting otherwise complex health information and also enabled seeking advice from other mothers. Finally, access to thousands of mothers across the world via Facebook discussion forums helped to normalize an otherwise isolating experience of parenting a newborn, linking mothers to others with similar experiences and challenges. Web-based resources are highly used sources of information for mothers and other new parents, and the data described here present some ways in which these sources may be tailored to meet the needs of Indigenous mothers while also mitigating the risks associated with unreliable information and self-diagnosis.
To the best of our knowledge, this study is the first to discuss Indigenous mothers’ use of web-based resources to support the health of their infants. This understanding is important for health care providers who wish to assist Indigenous mothers in meeting their health-related informational needs. This study and the literature has demonstrated that new and expecting parents are most commonly using internet sources of information to address questions and concerns related to parenting and newborn health, yet many are challenged by the rampant availability of misinformation, their inability to discern high-quality scores from low-quality sources, and understanding complex medical information [
Despite the high prevalence of access to smartphones and internet use among Canadians, our study found that just under 70% (13/19, 68%) of mothers used the internet in some form to answer health-related questions pertaining to their newborns. This number is significantly lower than many other studies that show that ≥90% of parents used the internet for this purpose [
The distrust of web-based information found in this study is a common finding among parents using the internet for infant-related health information [
This study found that Indigenous mothers most commonly used Google to meet their information needs on parenting and infant health issues. Fewer mothers reported using parenting apps and Facebook. This trend is similar to other studies, in which only half of internet users used parenting apps and Facebook was the most frequently used social media platform for parents [
Next, Facebook discussion forums were important to the Indigenous mothers in this study as they created a type of web- and app-based social network by instilling a sense of normalcy among thousands of other mothers with various experiences. This was particularly important for some mothers who had purposefully isolated themselves from friends and family who had negative influences in the past. Many participants had experienced negative health care encounters, racism, and discrimination within mainstream services and felt that their parenting was surveilled by child protection services. Indeed, both a lack of culturally safe health care services and Indigenous health care providers are barriers to safe and appropriate care for Indigenous families in Canada [
Mothers did not discuss the threat of cyberbullying as a reason why they chose not to interact with mothers on discussion forums and were not directly asked about this by the interviewer. However, in their personal lives, several mothers isolated themselves from friends and family members who they felt had a negative influence on their lives. The threat of negative interactions and the potential for cyberbullying if engaging with other mothers in web-based forums, therefore, may explain their insistence on anonymity.
Although these findings require verification with a larger sample size, they have several notable implications. First, Indigenous mothers, similar to other parents, require reliable sources of parenting and infant health information. Health care providers should suggest reputable websites to parents to assist them in making informed decisions based on high-quality information [
Given the historical, political, and social contexts that the participant mothers experience in their daily lives, these findings are likely to be relevant to other Indigenous parents who are similarly impacted by racism, discrimination, and social inequity stemming from colonization and subsequent discriminatory policies and stereotyping. Future research is needed to validate these findings with a larger and more representative group of Indigenous parents. Conversely, recognizing the vast diversity of Indigenous people in Canada, researchers seeking to create web-based information tools and technologies should collaborate with local Indigenous communities to ensure technology and content is relevant to local cultures, languages, and traditions.
How Indigenous mothers use web-based resources for their infants’ health has not been previously described in Canada, and further research is needed to better understand parents’ preferences and challenges and how best to address these needs. As this study focused on mothers as the primary caregivers of infants, future work to address the information needs of fathers and other parents (two spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual) is necessary. Finally, a more in-depth exploration of mothers’ hesitancy to interact on discussion forums might reveal the dangers of cyberbullying and suggest ways to mitigate these risks and promote the benefits of social interaction for otherwise isolated mothers.
Parents represent one of the most frequent users of web-based information, such as Google, apps, and Facebook. This study provided initial insights into how Indigenous mothers used web-based sources of information to meet the health needs of their infants and found that web-based sources were commonly used and were helpful to mothers. Significant challenges existed for mothers who navigated vast amounts of web-based information and attempted to interpret and apply the information to their lives. Health care providers should provide parents with reputable sources of web-based information pertaining to healthy parenting and infant health to assist parents in addressing their questions and making decisions about their infants’ health. Web-based modalities of health information appear to be useful opportunities to provide health education and health promotion to Indigenous mothers, and researchers and health care providers seeking to create these types of technologies should collaborate with local Indigenous communities to ensure relevancy.
The authors would like to acknowledge Dr Wahoush, Dr Ballantyne, Dr Gabel, and Dr Jack, who participated in the first author’s PhD committee. The authors would also like to sincerely thank the staff at the Hamilton Friendship Centre for assisting with recruitment and the mothers who bravely shared their stories to improve health care experiences for their families and communities. The first author received funding for this research from the Canadian Institutes of Health Research Fellowship, Priority Announcement: Research in First Nations, Métis, and/or Inuit Health (funding reference number: 146613).
ALW received personal fees from Mallinckrodt Pharmaceuticals for consultation and the reimbursement of travel fees for attending a neonatal conference. RV and VM declare no conflicts of interest.