@Article{info:doi/10.2196/67284,
author="Patchen, Loral
and Tsuei, Jeannette
and Sherard, Donna
and Moriarty, Patricia
and Mungai-Barris, Zoe
and Ma, Tony
and Bajracharya, Elina
and Chang, Katie
and Evans, Douglas William",
title="Designing a Digital Intervention to Increase Human Milk Feeding Among Black Mothers: Qualitative Study of Acceptability and Preferences",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="19",
volume="9",
pages="e67284",
keywords="health equity",
keywords="breastfeeding",
keywords="qualitative",
keywords="mobile health",
keywords="black mothers",
keywords="preferences",
keywords="cultural tailoring",
keywords="mobile phone",
abstract="Background: Breastfeeding rates among US mothers, particularly Black or African American mothers, fall short of recommended guidelines. Despite the benefits of human milk, only 24.9\% of all infants receive human milk exclusively at 6 months. Objective: Our team previously explored the key content areas a mobile health intervention should address and the usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app guided by preferences of Black or African American parents. This study aimed to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Key social branding elements were defined to guide app development as a trusted adviser. The study also aimed to validate previous findings regarding approaches to supporting breastfeeding goals and cultural tailoring. Methods: We conducted a qualitative study using in-depth interviews and focus groups with potential KULEA-NET users. A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. The Data methods aligned with qualitative research principles and concluded once saturation was reached. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, 1 with expertise in social branding and 1 certified in lactation, participated in the thematic analysis. Results: All participants identified as Black or African American mothers, and most interview participants (7/12, 58\%) engaged in exclusive breastfeeding. In total, 4 themes were recognized. First, participants identified desired content, specifying peer support, facilitated access to experts, geolocation to identify resources, and tracking functions. Second, delivery of content differentiated platforms and messaging modality. Third, functionality and features were identified as key factors, highlighting content diversity, ease of use, credibility, and interactivity. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in web-based forums and internet-based or in-person support groups to help balance the ideal medical recommendations for infant feeding with the contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility. Conclusions: This formative research suggested additional elements for an expanded KULEA-NET app that would be beneficial and desired. The health branding approach to establish KULEA-NET as a trusted adviser is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial. ",
doi="10.2196/67284",
url="https://formative.jmir.org/2025/1/e67284"
}


@Article{info:doi/10.2196/56142,
author="Muhammad, Shah
and Soomro, Asif
and Ahmed Khan, Samia
and Najmi, Hina
and Memon, Zahid
and Ariff, Shabina
and Soofi, Sajid
and Bhutta, Ahmed Zufiqar",
title="Scaling Up Kangaroo Mother Care Through a Facility Delivery Model in Rural Districts of Pakistan: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="29",
volume="14",
pages="e56142",
keywords="kangaroo mother care",
keywords="scale up intervention",
keywords="health facility",
keywords="community",
keywords="preterm infants",
abstract="Background: The neonatal mortality rate in Pakistan is the third highest in Asia, with 8.6 million preterm babies. These newborns require warmth, nutrition, and infection protection, typically provided by incubators. However, the high maintenance and repair costs of incubators pose a barrier to accessibility for many premature and low birth weight neonates in low- and middle-income countries. This study aims to implement a context-specific kangaroo mother care (KMC) model in Sanghar within secondary health care facilities and catchment communities. Objective: This study aims to achieve at least 80\% KMC coverage for premature and low birth weight neonates. Methods: This research uses a mixed methods design grounded in implementation science principles, with the goal of developing adaptive strategies tailored to district and facility managers, as well as health care workers, leveraging previous evidence on the benefits of KMC. The research is conducted in the district of Sanghar, Sindh with an emphasis on promoting KMC for infants weighing between 1200 and 2500 g in three facilities. It includes preimplementation data collection, training of health care providers and lady health workers, and intervention involving mother-baby skin-to-skin contact, breastfeeding initiation, and postdischarge follow-ups. Ethical considerations and data management are prioritized, to improve KMC coverage and neonatal health outcomes. Results: This research will be implemented over a period of 18 months. The primary objective of this research is to achieve an 80\% improvement in KMC coverage, with the secondary objective to promote optimal breastfeeding practices among postpartum mothers. Key indicators include the proportion of eligible infants enrolled in KMC, the percentage of mother-baby pairs receiving skin-to-skin care postdischarge, and the duration of KMC during the neonatal period. Additionally, the study will assess exclusive breastfeeding rates, neonatal weight gain, and neonatal deaths within the cohort. The data management team will evaluate the effectiveness of the model in achieving the targeted KMC coverage. Conclusions: The integration of KMC into the health care system will provide valuable insights for policy makers regarding effective implementation and scaling strategies. The study's findings will highlight facilitators and barriers to KMC adoption, benefiting regions across Pakistan and globally. Additionally, these findings will offer valuable insights for the development of future newborn care programs. International Registered Report Identifier (IRRID): DERR1-10.2196/56142 ",
doi="10.2196/56142",
url="https://www.researchprotocols.org/2025/1/e56142"
}


@Article{info:doi/10.2196/65247,
author="Krishnamurti, Tamar
and Moon, Rachel
and Richichi, Rudolph
and Berger, Rachel",
title="Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="14",
volume="8",
pages="e65247",
keywords="SIDS",
keywords="infant death",
keywords="sleep",
keywords="sudden infant death",
keywords="US",
keywords="United States",
keywords="infant",
keywords="infancy",
keywords="baby",
keywords="prenatal",
keywords="safe sleep",
keywords="breastfeeding",
keywords="infant care",
keywords="pregnancy",
keywords="app",
keywords="randomized controlled study",
keywords="TodaysBaby",
keywords="mobile health",
keywords="mHealth",
keywords="smartphone",
abstract="Background: Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. Objective: This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. Methods: This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5\% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app's learning center. Results: A total of 7572 pregnant persons were enrolled in the TodaysBaby Program---3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8\% with push notifications and 3.0\% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Conclusions: Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID---a leading cause of infant death after 1 month of age---appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact. ",
doi="10.2196/65247",
url="https://pediatrics.jmir.org/2025/1/e65247"
}


@Article{info:doi/10.2196/64191,
author="Fan, Lok Heidi Sze
and Leung, Yan Emily Tsz
and Lau, Wing Ka
and Wong, Ha Janet Yuen
and Choi, Hang Edmond Pui
and Lam, Christine
and Tarrant, Marie
and Ngan, Sheung Hextan Yuen
and Ip, Patrick
and Lin, Chin Chia
and Lok, Wan Kris Yuet",
title="A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="10",
volume="9",
pages="e64191",
keywords="Baby-Friendly Community Initiative",
keywords="Baby-Friendly Hospital Initiative",
keywords="breastfeeding",
keywords="community",
keywords="stakeholders",
keywords="mobile app",
keywords="friendly communities",
keywords="baby-friendly",
keywords="well-being",
keywords="mother",
keywords="infant",
keywords="application",
keywords="mHealth",
keywords="qualitative",
keywords="user-friendly",
keywords="self-management",
abstract="Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ``bfGPS'' (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged---bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant's growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app's potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. ",
doi="10.2196/64191",
url="https://formative.jmir.org/2025/1/e64191"
}


@Article{info:doi/10.2196/51566,
author="Huang, Yi-Yan
and Wang, Rong
and Huang, Wei-Peng
and Wu, Tian
and Wang, Shi-Yun
and R. Redding, Sharon
and Ouyang, Yan-Qiong",
title="Effects of a Smartphone-Based Breastfeeding Coparenting Intervention Program on Breastfeeding-Related Outcomes in Couples During First Pregnancy: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="17",
volume="26",
pages="e51566",
keywords="breastfeeding",
keywords="co-parenting",
keywords="randomized controlled",
keywords="child",
keywords="efficacy",
keywords="depressive symptoms",
abstract="Background: A low breastfeeding rate causes an increased health care burden and negative health outcomes for individuals and society. Coparenting is an essential tactic for encouraging breastfeeding when raising a child. The efficacy of the coparenting interventions in enhancing breastfeeding-related outcomes is controversial. Objective: This study aimed to examine the effects of coparenting interventions on exclusive breastfeeding rates, exclusive breastfeeding duration, breastfeeding knowledge, parenting sense of competence, coparenting relationships, depressive symptoms in new couples at 1 and 6 months post partum, and the BMI of infants 42 days post partum. Methods: This was a randomized, single-blinded controlled clinical trial. Eligible couples in late pregnancy in a hospital in central China were randomly assigned to 2 groups. While couples in the control group received general care, couples in the intervention group had access to parenting classes, a fathers' support group, and individual counseling. Data were collected at baseline (T0), 1 month post partum (T1), and 6 months post partum (T2). Data on exclusive breastfeeding rate and exclusive breastfeeding duration were analyzed using the chi-square, Fisher exact, or Mann-Whitney U tests; coparenting relationships and the infant's BMI were analyzed using an independent samples t test; and breastfeeding knowledge, parenting sense of competence, and depressive symptoms were analyzed using a generalized estimation equation. Results: A total of 96 couples were recruited, and 79 couples completed the study. The intervention group exhibited significantly higher exclusive breastfeeding rates at T1 (90\% vs 65\%, P=.02) and T2 (43.6\% vs 22.5\%, P=.02), compared with the control group. Exclusive breastfeeding duration was extended in the intervention group than in the control group at T1 (30, range 30-30 days vs 30, range 26.5-30 days; P=.01) and T2 (108, range 60-180 days vs 89, range 28-149.3 days; P<.05). The intervention group exhibited greater improvements in maternal breastfeeding knowledge ($\beta$=.07, 95\% CI 0.006-0.13; P=.03) and maternal parenting sense of competence ($\beta$=5.49, 95\% CI 2.09-8.87; P<.01) at T1, enhanced coparenting relationships at T1 (P<.001) and T2 (P=.02), paternal breastfeeding knowledge at T2 ($\beta$=.25, 95\% CI 0.15-0.35, P<.001), paternal parenting sense of competence at T1 ($\beta$=5.35, 95\% CI 2.23-8.47, P<.01), and reduced paternal depressive symptoms at T2 ($\beta$=.25, 95\% CI 0.15-0.35, P<.001), and there was a rise in infants' BMI at 42 days post partum ($\beta$=.33, 95\% CI 0.01-0.64, P=.04). Conclusions: An evidence-based breastfeeding coparenting intervention is effective in improving exclusive breastfeeding rate, prolonging exclusive breastfeeding duration within the initial 6 months post partum, enhancing parental breastfeeding knowledge, levels of parenting sense of competence and coparenting relationship, infant's BMI, and reducing paternal depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069648; https://tinyurl.com/2p8st2p8 ",
doi="10.2196/51566",
url="https://www.jmir.org/2024/1/e51566"
}


@Article{info:doi/10.2196/53720,
author="Hanach, Nivine
and Saqan, Roba
and Radwan, Hadia
and Baniissa, Wegdan
and de Vries, Nanne",
title="Perceived Experiences and Needs of Digital Resources Among Postpartum Women in the United Arab Emirates: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="16",
volume="26",
pages="e53720",
keywords="digital health",
keywords="social support",
keywords="telemedicine",
keywords="postpartum women",
keywords="focus group",
keywords="maternal health",
keywords="postpartum mental health",
keywords="postpartum depression",
keywords="emotional support",
keywords="health information",
abstract="Background: The postpartum period is a critical phase in a woman's life, marked by various physical, psychological, and social challenges. In light of the rapid proliferation and uptake of digital technologies, particularly in the United Arab Emirates (UAE), mothers increasingly seek informational and emotional support from digital resources. No previous study has thoroughly explored the usage of various digital resources beyond telehealth services in the UAE. This literature gap is particularly relevant for the postpartum period, which remains largely understudied in the UAE. Objective: This study aims to delve into the digital experiences of postpartum women in the UAE by exploring the types of resources they navigate and the purposes those resources serve. In addition, it seeks to identify their perspectives and needs regarding digital resources that support their postpartum journey. Methods: Four focus groups were conducted synchronously on the web, involving a total of 27 multicultural mothers (mean age 32.47, SD 4.56 years), between 2 and 12 months post partum and living in the UAE. Descriptive interpretive thematic analysis was used to analyze the data. Results: Sixteen out of 27 women exhibited severe depressive symptoms at the time of the discussions (Edinburgh Postnatal Depression Scale score of >12). Two main themes were generated from the analysis: (1) Mothers' Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. Conclusions: This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes. ",
doi="10.2196/53720",
url="https://www.jmir.org/2024/1/e53720",
url="http://www.ncbi.nlm.nih.gov/pubmed/39680428"
}


@Article{info:doi/10.2196/53560,
author="Sosanya, Eloho Mercy
and Samuel, Olukemi Folake
and Bashir, Sadia
and Omoera, Osariemen Victoria
and Freeland-Graves, H. Jeanne",
title="A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="26",
volume="26",
pages="e53560",
keywords="mobile health",
keywords="mHealth",
keywords="mobile gaming app",
keywords="validation",
keywords="infant and young child feeding",
keywords="teenage mother",
keywords="Nigeria",
keywords="mobile phone",
abstract="Background: Undernutrition is an underlying factor in nearly 50\% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. Objective: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. Methods: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country's capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. Results: Large proportions of the study participants were married (53/90, 59\%) and had no personal income (63/90, 70\%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80\%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). Conclusions: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria. ",
doi="10.2196/53560",
url="https://www.jmir.org/2024/1/e53560"
}


@Article{info:doi/10.2196/57254,
author="Sharma, Divya
and Yadav, Jyoti
and Gupta, Madhu
and Halder, Pritam
and Rajan, K. Abin
and Kiran, Tanvi",
title="Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="24",
volume="10",
pages="e57254",
keywords="breastfeeding",
keywords="institutional deliveries",
keywords="delayed initiation",
keywords="moderation analysis",
keywords="Indian mothers",
keywords="socio-economic",
keywords="cross-sectional study",
keywords="infant",
keywords="infancy",
keywords="infant feeding",
keywords="human milk",
keywords="breastfeeding initiation",
keywords="mother",
keywords="women",
keywords="India",
keywords="healthcare services",
keywords="awareness",
keywords="pregnancy",
keywords="public health",
abstract="Background: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. Objective: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. Methods: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression--based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. Results: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ?36 years (58.3\%), lacking formal education (60.9\%), belonging to lower wealth groups (58.1\%), residing in rural areas (57.4\%), and having home births (64.1\%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95\% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95\% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95\% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95\% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95\% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. Conclusions: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation. ",
doi="10.2196/57254",
url="https://publichealth.jmir.org/2024/1/e57254",
url="http://www.ncbi.nlm.nih.gov/pubmed/39316434"
}


@Article{info:doi/10.2196/55411,
author="Piris-Borregas, Salvador
and Bell{\'o}n-Vaquerizo, Beatriz
and Velasco-Echebur{\'u}a, Leticia
and Ni{\~n}o-D{\'i}az, Lidia
and S{\'a}nchez-Aparicio, Susana
and L{\'o}pez-Maestro, Mar{\'i}a
and Pall{\'a}s-Alonso, Rosa Carmen",
title="Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Aug",
day="30",
volume="7",
pages="e55411",
keywords="family-centered care",
keywords="neonatal intensive care unit",
keywords="kangaroo mother care",
keywords="mother",
keywords="mothers",
keywords="parent",
keywords="parents",
keywords="parental",
keywords="ICU",
keywords="intensive care",
keywords="training",
keywords="education",
keywords="educational",
keywords="premature",
keywords="pediatric",
keywords="pediatrics",
keywords="paediatric",
keywords="paediatrics",
keywords="infant",
keywords="infants",
keywords="infancy",
keywords="baby",
keywords="babies",
keywords="neonate",
keywords="neonates",
keywords="neonatal",
keywords="newborn",
keywords="newborns",
keywords="intensive care unit",
abstract="Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low--birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cu{\'i}dame (meaning ``Take Care of Me'' in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5?20 vs 7, IQR 4?10.5 d; P<.001), feeding (median 53.5, IQR 34?68 vs 44.5, IQR 37?62 d; P=.049), and observation of neurobehavior (median 18, IQR 9?33 vs 11, IQR 7?16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7?23 vs 21, IQR 10?31 d; P=.02), diaper change (median 9.5, IQR 4?20 vs 14.5, IQR 9?32 d; P=.04), and infection prevention (median 1, IQR 1?2 vs 6, IQR 3?12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. ",
doi="10.2196/55411",
url="https://pediatrics.jmir.org/2024/1/e55411"
}


@Article{info:doi/10.2196/54768,
author="Sonephet, Souliviengkham
and Kounnavong, Sengchanh
and Zinsstag, Lucienne
and Vonaesch, Pascale
and Sayasone, Somphou
and Siengsounthone, Latsamy
and Odermatt, Peter
and Fink, G{\"u}nther
and Wallenborn, Tinka Jordyn",
title="Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People's Democratic Republic: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="3",
volume="13",
pages="e54768",
keywords="breastfeeding",
keywords="lactation",
keywords="human milk",
keywords="breastmilk",
keywords="child",
keywords="infant",
keywords="health",
keywords="growth and development",
keywords="cash transfer",
keywords="incentive",
keywords="intervention",
abstract="Background: Children in Lao People's Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR. Objective: This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR. Methods: A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80\% power to detect an increase in exclusive breastfeeding from the anticipated 21\% in the control arm to 40\% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information. Results: As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93\% have completed all visits. Conclusions: We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. Trial Registration: ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049 International Registered Report Identifier (IRRID): DERR1-10.2196/54768 ",
doi="10.2196/54768",
url="https://www.researchprotocols.org/2024/1/e54768",
url="http://www.ncbi.nlm.nih.gov/pubmed/38700928"
}


@Article{info:doi/10.2196/50191,
author="Howell, Khadesia
and Alvarado, Gabriela
and Waymouth, Molly
and Demirci, Jill
and Rogers, Rhianna
and Ray, Kristin
and Uscher-Pines, Lori",
title="Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="29",
volume="25",
pages="e50191",
keywords="acceptance",
keywords="barrier",
keywords="black parent",
keywords="black",
keywords="breastfeeding",
keywords="concordance",
keywords="consultant",
keywords="consultation",
keywords="digital divide",
keywords="digital equity",
keywords="disparity",
keywords="ethnic",
keywords="health equity",
keywords="lactation",
keywords="mother",
keywords="parent",
keywords="racial",
keywords="telehealth",
keywords="telelactation",
keywords="user",
abstract="Background: While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. Objective: We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. Methods: We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health--funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation's equity-centered model. Results: Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. Conclusions: While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations. ",
doi="10.2196/50191",
url="https://www.jmir.org/2023/1/e50191",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157241"
}


@Article{info:doi/10.2196/43837,
author="Haramati, Sharon
and Firsow, Anastasia
and Navarro, Abigail Daniela
and Shechter, Ravid",
title="Novel At-Home Mother's Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment",
journal="JMIR Pediatr Parent",
year="2023",
month="Aug",
day="22",
volume="6",
pages="e43837",
keywords="breastfeeding",
keywords="feasibility",
keywords="human milk",
keywords="biomarker",
keywords="remote sensing technology",
keywords="mobile health",
keywords="retrospective",
keywords="secretory activation",
keywords="lactogenesis",
keywords="milk supply",
keywords="milk",
keywords="sensing technology",
keywords="monitoring tool",
keywords="lactation",
keywords="exclusive breastfeeding",
keywords="breastfeed",
keywords="maternal health",
keywords="maternal and infant health",
keywords="infant health",
keywords="maternal and child health",
keywords="prolactin",
keywords="lactation consultant",
keywords="lactation support provider",
keywords="mother",
keywords="milk maturation",
abstract="Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM\%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth--dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system's results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM\%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM\% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth--dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. ",
doi="10.2196/43837",
url="https://pediatrics.jmir.org/2023/1/e43837",
url="http://www.ncbi.nlm.nih.gov/pubmed/37464893"
}


@Article{info:doi/10.2196/44329,
author="Bahorski, Jessica
and Romano, Mollie
and McDougal, May Julie
and Kiratzis, Edie
and Pocchio, Kinsey
and Paek, Insu",
title="Development of an Individualized Responsive Feeding Intervention---Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="28",
volume="12",
pages="e44329",
keywords="responsive feeding",
keywords="infant growth",
keywords="infant nutrition",
abstract="Background: Responsive infant feeding occurs when a parent recognizes the infant's cues of hunger or satiety and responds promptly to these cues. It is known to promote healthy dietary patterns and infant weight gain and is recommended as part of the Dietary Guidelines for Americans. However, the use of responsive infant feeding can be challenging for many parents. Research is needed to assist caregivers recognize infant hunger or satiety cues and overcoming barriers to using responsive infant feeding. Objective: The Learning Early Infant Feeding Cues (LEIFc) intervention was designed to fill this gap by using a validated coaching approach, SS-OO-PP-RR (``super,'' Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review), to promote responsive infant feeding. Guided by the Obesity-Related Behavioral Intervention Trials model, this study aims to test the feasibility and fidelity of the LEIFc intervention in a group of mother-infant dyads. Methods: This pre-post quasi-experimental study with no control group will recruit mothers (N=30) in their third trimester (28 weeks and beyond) of pregnancy from community settings. Study visit 1 will occur prenatally in which written and video material on infant feeding and infant hunger and satiety cues is provided. Demographic information and plans for infant feeding are also collected prenatally via self-report surveys. The use of responsive infant feeding via subjective (survey) and objective (video) measures is recorded before (study visit 2, 1 month post partum) and after (study visit 5, 4 months post partum) intervention. Coaching on responsive infant feeding during a feeding session is provided by a trained interventionist using the SS-OO-PP-RR approach at study visits 3 (2 months post partum) and 4 (3 months post partum). Infant feeding practices are recorded via survey, and infant weight and length are measured at each postpartum study visit. Qualitative data on the LEIFc intervention are provided by the interventionist and mother. Infant feeding videos will be coded and tabulated for instances of infant cues and maternal responses. Subjective measures of responsive infant feeding will also be tabulated. The use of responsive infant feeding pre-post intervention will be analyzed using matched t tests. Qualitative data will be examined to guide intervention refinement. Results: This study initially began in spring 2020 but was halted because of the COVID-10 pandemic. With new funding, recruitment, enrollment, and data collection began in April 2022 and will continue until April 2023. Conclusions: After refinement, the LEIFc intervention will be tested in a pilot randomized controlled trial. The long-term goal is to implement LEIFc in the curricula of federally funded maternal-child home visiting programs that serve vulnerable populations---those that often have infant feeding practices that do not align with recommendations and are less likely to use responsive infant feeding. International Registered Report Identifier (IRRID): DERR1-10.2196/44329 ",
doi="10.2196/44329",
url="https://www.researchprotocols.org/2023/1/e44329",
url="http://www.ncbi.nlm.nih.gov/pubmed/36853761"
}


@Article{info:doi/10.2196/31475,
author="Mihrshahi, Seema
and Ara, Gulshan
and Khanam, Mansura
and Rasheed, Sabrina
and Agho, Emwinyore Kingsley
and Kabir, Iqbal A. K. M.
and Roy, K. S.
and Haider, Rukhsana
and Derakhshani Hamadani, Jena
and Tofail, Fahmida
and Alam, Ashraful
and Dibley, J. Michael",
title="The Shishu Pushti Trial--Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="7",
volume="11",
number="2",
pages="e31475",
keywords="child stunting",
keywords="prevention",
keywords="nutrition behavior change",
keywords="breastfeeding: infant and young child feeding",
keywords="peer counseling, child development",
abstract="Background: The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. Objective: Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. Methods: This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements.The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). Results: We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. Conclusions: This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. Trial Registration: ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995 International Registered Report Identifier (IRRID): DERR1-10.2196/31475 ",
doi="10.2196/31475",
url="https://www.researchprotocols.org/2022/2/e31475",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129457"
}


@Article{info:doi/10.2196/28156,
author="Ariff, Shabina
and Habib, Atif
and Memon, Zahid
and Arshad, Tayyaba
and Samejo, Tariq
and Maznani, Ikram
and Umer, Muhammad
and Hussain, Amjad
and Rizvi, Arjumand
and Ahmed, Imran
and Soofi, Bashir Sajid
and Bhutta, A. Zulfiqar",
title="Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="10",
volume="10",
number="8",
pages="e28156",
keywords="community kangaroo mother care",
keywords="low birth weight",
keywords="KMC champions",
keywords="neonatal mortality",
keywords="RCT protocol",
keywords="Pakistan",
abstract="Background: Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country. Objective: The primary objective of this trial is to reduce neonatal mortality among preterm and LBW infants. The secondary objectives are growth (measured as weight gain), reduced incidence of possible serious bacterial infection, and increased exclusive breastfeeding and continued breastfeeding practices. Methods: We designed a community-based cluster randomized controlled trial in one rural district of Pakistan. Stable, LBW babies (weighing 1200 grams to 2500 grams) are included in the study. The community KMC package, consisting of the KMC kit, information and counseling material, and community mobilization through KMC champions (village volunteers), was designed after preliminary research in the same geographical location and implemented in intervention clusters. The standard essential newborn care is offered in the control clusters. Infants are recruited and followed up by independent teams of data collectors. Data are collected on the duration of skin-to-skin contact, growth, breastfeeding practices, morbidities, neonatal mortality, and neurodevelopment status. Data analysis will be conducted based on the intention to treat principle. The Cox regression model will be used to assess the primary outcome of neonatal mortality. The secondary outcomes will be evaluated using linear or logistic regression. Results: The Ethics Review Committee of Aga Khan University, Pakistan, approved the study protocol in February 2017. Data collection began in August 2019 and will be completed in December 2021. Data analyses are yet to be completed. Conclusions: This intervention may be effective in preventing sepsis and subsequently improve survival in LBW newborns in Pakistan and other low-income and middle-income countries worldwide. Trial Registration: clinicaltrials.gov NCT03545204; https://clinicaltrials.gov/ct2/show/NCT03545204 International Registered Report Identifier (IRRID): DERR1-10.2196/28156 ",
doi="10.2196/28156",
url="https://www.researchprotocols.org/2021/8/e28156",
url="http://www.ncbi.nlm.nih.gov/pubmed/34170839"
}


@Article{info:doi/10.2196/26098,
author="Qian, Jiafen
and Wu, Tingting
and Lv, Meina
and Fang, Zongwei
and Chen, Mingrong
and Zeng, Zhiwei
and Jiang, Shaojun
and Chen, Wenjun
and Zhang, Jinhua",
title="The Value of Mobile Health in Improving Breastfeeding Outcomes Among Perinatal or Postpartum Women: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="16",
volume="9",
number="7",
pages="e26098",
keywords="mHealth",
keywords="breastfeeding",
keywords="randomized controlled trial",
keywords="meta-analysis",
abstract="Background: Breastfeeding is essential for maintaining the health of mothers and babies. Breastfeeding can reduce the infection rate and mortality in newborns, and can reduce the chances of overweight and obesity in children and adolescents. For mothers, a longer duration of breastfeeding can reduce the risk of breast cancer, ovarian cancer, and type 2 diabetes. Although breastfeeding has many benefits, the global breastfeeding rate is low. With the progress of time, the popularity of mobile devices has increased rapidly, and interventions based on mobile health (mHealth) may have the potential to facilitate the improvement of the breastfeeding status. Objective: The main objective of this study was to analyze the existing evidence to determine whether mHealth-based interventions can improve the status of breastfeeding. Methods: We systematically searched multiple electronic databases (PubMed, Web of Science, The Cochrane Library, Embase, CNKI, WanFang, and Vip ) to identify eligible studies published from 1966 to October 29, 2020. Included studies were randomized controlled trials (RCTs) studying the influence of mHealth on breastfeeding. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RevMan 5.3 was used to analyze the data. Results: A total of 15 RCTs with a total sample size of 4366 participates met the inclusion criteria. Compared with usual care, interventions based on mHealth significantly increased the postpartum exclusive breastfeeding rate (odds ratio [OR] 3.18, 95\% CI 2.20-4.59; P<.001), enhanced breastfeeding self-efficacy (mean difference [MD] 8.15, 95\% CI 3.79-12.51; P=.002; I2=88\%), reduced health problems in infants (OR 0.62, 95\% CI 0.43-0.90; P=.01; I2=0\%), and improved participants' attitudes toward breastfeeding compared with usual care (MD 3.94, 95\% CI 1.95-5.92; P<.001; I2=0\%). There was no significant difference in the initiation of breastfeeding within an hour of birth between the intervention group and the usual care group (OR 1.26, 95\% CI 0.55-2.90; P=.59). In addition, subgroup analysis was carried out according to different subjects and publication times. The results showed that the breastfeeding rate was not limited by the types of subjects. The breastfeeding rate based on mHealth at 1 month and 2 months after delivery did not change over the time of publication (2009 to 2020), and the breastfeeding rate based on mHealth at 3 months and 6 months after delivery gradually increased with time (2009 to 2020). Conclusions: Interventions based on mHealth can significantly improve the rate of postpartum exclusive breastfeeding, breastfeeding efficacy, and participants' attitudes toward breastfeeding, and reduce health problems in infants. Therefore, encouraging women to join the mHealth team is feasible, and breastfeeding-related information can be provided through simple measures, such as text messages, phone calls, and the internet, to improve the health of postpartum women and their babies. ",
doi="10.2196/26098",
url="https://mhealth.jmir.org/2021/7/e26098",
url="http://www.ncbi.nlm.nih.gov/pubmed/34269681"
}


@Article{info:doi/10.2196/23115,
author="Manjong, Titu Florence
and Verla, Siysi Vincent
and Egbe, Obinchemti Thomas
and Nsagha, Shey Dickson",
title="Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="20",
volume="10",
number="5",
pages="e23115",
keywords="nutrition education",
keywords="caregivers",
keywords="nutrition outcomes",
keywords="indigenous children",
abstract="Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce. Objective: This study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers' knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon. Methods: A two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child--caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers' peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers' knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea. Results: Baseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child--caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript. Conclusions: The findings of this study will provide evidence on the impact of culturally tailored and health belief model--based nutrition education on behavior change as a complementary strategy for strengthening health facility--based approaches in the reduction of malnutrition burden among the study population International Registered Report Identifier (IRRID): DERR1-10.2196/23115 ",
doi="10.2196/23115",
url="https://www.researchprotocols.org/2021/5/e23115",
url="http://www.ncbi.nlm.nih.gov/pubmed/34014173"
}


@Article{info:doi/10.2196/29048,
author="Taylor, W. Rachael
and Conlon, A. Cathryn
and Beck, L. Kathryn
and von Hurst, R. Pamela
and Te Morenga, A. Lisa
and Daniels, Lisa
and Haszard, J. Jill
and Meldrum, M. Alison
and McLean, H. Neve
and Cox, M. Alice
and Tukuafu, Lesieli
and Casale, Maria
and Brown, J. Kimberley
and Jones, A. Emily
and Katiforis, Ioanna
and Rowan, Madeleine
and McArthur, Jenny
and Fleming, A. Elizabeth
and Wheeler, J. Ben
and Houghton, A. Lisa
and Diana, Aly
and Heath, M. Anne-Louise",
title="Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="21",
volume="10",
number="4",
pages="e29048",
keywords="infant",
keywords="diet",
keywords="complementary feeding",
keywords="food pouch",
keywords="baby-led weaning",
keywords="iron",
keywords="growth",
keywords="eating behavior",
keywords="feeding behavior",
keywords="dental health",
keywords="choking",
keywords="breast milk",
abstract="Background: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100\% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food ``pouches'' and ``baby-led weaning'' (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed pur{\'e}es, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. Objective: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. Methods: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide ``dose-to-mother'' technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. Results: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. Conclusions: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. International Registered Report Identifier (IRRID): DERR1-10.2196/29048 ",
doi="10.2196/29048",
url="https://www.researchprotocols.org/2021/4/e29048",
url="http://www.ncbi.nlm.nih.gov/pubmed/33881411"
}


@Article{info:doi/10.2196/25668,
author="Musgrave, M. Loretta
and Baum, Alison
and Perera, Nilushka
and Homer, SE Caroline
and Gordon, Adrienne",
title="Baby Buddy App for Breastfeeding and Behavior Change: Retrospective Study of the App Using the Behavior Change Wheel",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="15",
volume="9",
number="4",
pages="e25668",
keywords="breastfeeding",
keywords="app",
keywords="digital health",
keywords="smartphone app",
keywords="behavior change wheel",
keywords="digital behavior change intervention",
abstract="Background: Breastfeeding plays a major role in the health of mothers and babies and has the potential to positively shape an individual's life both in the short and long term. In the United Kingdom (UK), although 81\% of women initiate breastfeeding, only 1\% of women breastfeed exclusively to 6 months as recommended by the World Health Organization. In the UK, women who are socially disadvantaged and younger are less likely to breastfeed at 6 to 8 weeks postpartum. One strategy that aims to improve these statistics is the Baby Buddy app, which has been designed and implemented by the UK charity Best Beginnings to be a universal intervention to help reduce health inequalities, including those in breastfeeding. Objective: This study aimed to retrospectively examine the development of Baby Buddy by applying the Behavior Change Wheel (BCW) framework to understand how it might increase breastfeeding self-efficacy, knowledge, and confidence. Methods: Retrospective application of the BCW was completed after the app was developed and embedded into maternity services. A three-stage process evaluation used triangulation methods and formalized tools to gain an understanding of the potential mechanisms and behaviors used in apps that are needed to improve breastfeeding rates in the UK. First, we generated a behavioral analysis by mapping breastfeeding barriers and enablers onto the Capability, Opportunity, and Motivation-Behavior (COM-B) system using documents provided by Best Beginnings. Second, we identified the intervention functions and policy categories used. Third, we linked these with the behavior change techniques identified in the app breastfeeding content using the Behavior Change Techniques Taxonomy (BCTTv1). Results: Baby Buddy is a well-designed platform that could be used to change breastfeeding behaviors. Findings from stage one showed that Best Beginnings had defined breastfeeding as a key behavior requiring support and demonstrated a thorough understanding of the context in which breastfeeding occurs, the barriers and enablers of breastfeeding, and the target actions needed to support breastfeeding. In stage two, Best Beginnings had used intervention and policy functions to address the barriers and enablers of breastfeeding. In stage three, Baby Buddy had been assessed for acceptability, practicability, effectiveness, affordability, safety, and equity. Several behavior change techniques that could assist women with decision making around breastfeeding (eg, information about health consequences and credible sources) and possibly affect attitudes and self-efficacy were identified. Of the 39 videos in the app, 19 (49\%) addressed physical capabilities related to breastfeeding and demonstrated positive breastfeeding behaviors. Conclusions: Applying a theoretical framework retrospectively to a mobile app is possible and results in useful information to understand potential health benefits and to inform future development. Future research should assess which components and behavioral techniques in the app are most effective in changing behavior and supporting breastfeeding. ",
doi="10.2196/25668",
url="https://mhealth.jmir.org/2021/4/e25668",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856351"
}


@Article{info:doi/10.2196/27382,
author="Burduli, Ekaterina
and Jones, E. Hendr{\'e}e
and Brooks, Olivia
and Barbosa-Leiker, Celestina
and Johnson, Kim Ron
and Roll, John
and McPherson, Marshall Sterling",
title="Development and Implementation of a Mobile Tool for High-Risk Pregnant Women to Deliver Effective Caregiving for Neonatal Abstinence Syndrome: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="15",
volume="10",
number="4",
pages="e27382",
keywords="neonatal abstinence syndrome",
keywords="opioid use disorder",
keywords="mHealth",
keywords="maternal child outcomes",
abstract="Background: The United States continues to experience an alarming rise in opioid use that includes women who become pregnant and related neonatal abstinence syndrome (NAS) in newborns. Most newborns experiencing NAS require nonpharmacological care, which entails, most importantly, maternal involvement with the newborn. To facilitate positive maternal-newborn interactions, mothers need to learn effective caregiving NAS strategies when they are pregnant; however, an enormous gap exists in the early education of mothers on the symptoms and progression of NAS, partly because no education, training, or other interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. Objective: In this paper, we describe a mixed methods, multistage study to adapt an existing mobile NAS tool for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled trial. Methods: Stage 1 will include 20 semistructured interviews with a panel of neonatology experts, NAS care providers, and mothers with experience caring for NAS-affected newborns to gather their recommendations on the management of NAS and explore their perspectives on the care of these newborns. The findings will guide the adaptation of existing mobile NAS tools for high-risk pregnant women. In stage 2, we will test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT). Finally, in stage 3, we will randomize 30 high-risk pregnant women receiving OAT to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these women on primary outcomes---maternal drug relapse and OAT continuation---and secondary outcomes---maternal-newborn bonding; length of newborn hospital stays; readmission rates; breastfeeding initiation and duration; and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Results: This project was funded in July 2020 and approved by the institutional review board in April 2020. Data collection for stage 1 began in December 2020, and as of January 2021, we completed 18 semistructured interviews (10 with NAS providers and 8 with perinatal women receiving OAT). Common themes from all interviews will be analyzed in spring 2021 to inform the adaptation of the NAS caregiving tool. The results from stage 1 are expected to be published in summer 2021. Stage 2 data collection will commence in fall 2021. Conclusions: The findings of this study have the potential to improve NAS care and maternal-newborn outcomes and lead to commercialized product development. If effective, our new tool will be well suited to tailoring for other high-risk perinatal women with substance use disorders. Trial Registration: ClinicalTrials.gov NCT04783558; https://clinicaltrials.gov/ct2/show/NCT04783558 International Registered Report Identifier (IRRID): DERR1-10.2196/27382 ",
doi="10.2196/27382",
url="https://www.researchprotocols.org/2021/4/e27382",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856360"
}


@Article{info:doi/10.2196/23994,
author="Ariff, Shabina
and Soofi, Sajid
and Aamir, Almas
and D'Almeida, Michelle
and Aziz Ali, Arzina
and Alam, Ashraful
and Dibley, Michael",
title="Bovine Lactoferrin to Prevent Neonatal Infections in Low-Birth-Weight Newborns in Pakistan: Protocol for a Three-Arm Double-Blind Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="11",
volume="10",
number="3",
pages="e23994",
keywords="bovine lactoferrin",
keywords="low birth weight",
keywords="sepsis",
keywords="human milk",
keywords="premature",
keywords="mortality",
abstract="Background: Sepsis is a common and severe complication in premature neonates, particularly those born with low birth weights (<2500 g). Neonatal sepsis is steadily emerging as a leading cause of neonatal mortality in Pakistan. Lactoferrin is a natural product with broad-spectrum antimicrobial properties and glycoprotein that is actively involved in innate immune host responses. Clinical trials have revealed its protective effect on sepsis, but lactoferrin dosage, duration, and role in the prevention of sepsis are still uncertain. Objective: We aimed to establish the efficacy of bovine lactoferrin in the prevention of late-onset sepsis and to determine the optimal dose and method of administering bovine lactoferrin that may contribute to improvement in overall survival of low birth weight infants. Methods: We will implement the study in 2 phases at the Aga Khan University Hospital. The first phase, which we have completed, was formative research. This phase mainly focused on a qualitative exploration of perceptions about feeding and caring practices of low birth weight newborns and a trial of improved practices for the preparation and administration of bovine lactoferrin to newborns. The second phase is a 3-arm double-blind randomized controlled trial. In this phase, we randomly allocated 2 different daily oral prophylactic doses of bovine lactoferrin (150 mg or 300 mg) and placebo to 300 low--birth weight neonates starting within the first 72 hours of birth and continuing for the first 28 days of life. Results: The study protocol was approved by the Ethics Review Committee of Aga Khan University on August 16, 2017. Data collection began in April 2018 and was completed in September 2020. Data analyses are yet to be completed. We expect the results to be published in peer-reviewed journals by autumn of 2021. Conclusions: This intervention, if effective, has the potential to be translated into a safe, affordable, and widely utilized treatment to prevent sepsis and, subsequently, may improve the survival outcomes of low birth weight neonates in Pakistan and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03431558; https://clinicaltrials.gov/ct2/show/NCT03431558 International Registered Report Identifier (IRRID): PRR1-10.2196/23994 ",
doi="10.2196/23994",
url="https://www.researchprotocols.org/2021/3/e23994",
url="http://www.ncbi.nlm.nih.gov/pubmed/33704071"
}


@Article{info:doi/10.2196/18240,
author="Militello, Lisa
and Sezgin, Emre
and Huang, Yungui
and Lin, Simon",
title="Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="1",
volume="5",
number="3",
pages="e18240",
keywords="perinatal care",
keywords="infant mortality",
keywords="health education",
keywords="mobile health",
keywords="feasibility studies",
keywords="family",
keywords="mobile phone",
keywords="webcasts as topic",
keywords="user-computer interface",
abstract="Background: Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. Objective: The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. Methods: Perinatal women were recruited from a large Midwest Children's Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention--Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants' perceptions of voice technology as a means to support perinatal health in the future. Results: In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). Conclusions: Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions. ",
doi="10.2196/18240",
url="https://formative.jmir.org/2021/3/e18240",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646136"
}


@Article{info:doi/10.2196/18154,
author="Lawton, Beverley
and Storey, Francesca
and Sibanda, Nokuthaba
and Bennett, Matthew
and Lambert, Charles
and Geller, Stacie
and Edmonds, Liza
and Cram, Fiona",
title="He Korowai Manaaki (Pregnancy Wraparound Care): Protocol for a Cluster Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="29",
volume="10",
number="1",
pages="e18154",
keywords="maternity",
keywords="inequity",
keywords="Indigenous health",
keywords="M?ori",
keywords="pregnancy",
keywords="Kaupapa M?ori",
keywords="socioeconomic",
keywords="primary health care",
keywords="methodology",
abstract="Background: Maternal and infant health inequities between M?ori (the Indigenous peoples of Aotearoa New Zealand) and New Zealand European women are well documented and cannot be explained solely by socioeconomic status. A research center-iwi (tribal group) partnership aims to address these disparities and improve maternal and infant health outcomes by implementing an augmented maternity care pathway (He Korowai Manaaki) to improve access to services and evidence-informed care. Objective: The objective of this study is to test whether an augmented maternity care pathway improves M?ori infant health outcomes. Methods: This is a Kaupapa M?ori (by, with, and for M?ori) cluster randomized clinical trial involving 8 primary care practices allocated to either an intervention arm or control arm. The intervention arm comprises an augmented maternity care pathway (He Korowai Manaaki) offering clinical care through additional paid health care appointments and improved access to social support (eg, housing, transport). The control arm is usual care. The primary outcome is increased timely vaccination for M?ori infants, defined as all age-appropriate vaccinations completed by 6 months of age. Results: Recruitment commenced in November 2018 and was completed in June 2020, with 251 enrolled women recruited in intervention primary care practices before 20 weeks of pregnancy. Publication of results is anticipated in late 2023. Conclusions: The results will inform primary health care policy including whether the provision of augmented maternal care pathways reduces disparities in the structural determinants of health. If effective, He Korowai Manaaki will strengthen the health and well-being of pregnant M?ori women and their babies and improve their health outcomes, laying a strong foundation for lifelong health and well-being. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001155189; https://tinyurl.com/yypbef8q International Registered Report Identifier (IRRID): DERR1-10.2196/18154 ",
doi="10.2196/18154",
url="http://www.researchprotocols.org/2021/1/e18154/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33512321"
}


@Article{info:doi/10.2196/23273,
author="Wu, Qiong
and Huang, Yiwen
and Liao, Zijun
and van Velthoven, Helena Michelle
and Wang, Wei
and Zhang, Yanfeng",
title="Effectiveness of WeChat for Improving Exclusive Breastfeeding in Huzhu County China: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="3",
volume="22",
number="12",
pages="e23273",
keywords="breastfeeding",
keywords="exclusive breastfeeding",
keywords="WeChat",
keywords="mHealth",
keywords="randomized controlled trial",
abstract="Background: The benefits of breastfeeding for both infants and mothers have been well recognized. However, the exclusive breastfeeding rate in China is low and decreasing. Mobile technologies have rapidly developed; communication apps such as WeChat (one of the largest social networking platforms in China) are widely used and have the potential to conveniently improve health behaviors. Objective: This study aimed to assess the effectiveness of using WeChat to improve breastfeeding practices. Methods: This 2-arm randomized controlled trial was conducted among pregnant women from May 2019 to April 2020 in Huzhu County, Qinghai Province, China. Pregnant women were eligible to participate if they were aged 18 years or older, were 11 to 37 weeks pregnant with a singleton fetus, had no known illness that could limit breastfeeding after childbirth, used WeChat through their smartphone, and had access to the internet. A total of 344 pregnant women were recruited at baseline, with 170 in the intervention group and 174 in the control group. Women in the intervention group received breastfeeding knowledge and promotion information weekly through a WeChat official account from their third month of pregnancy to 6 months postpartum. The primary outcome of exclusive and predominant breastfeeding rate was measured 0-1 month, 2-3 months, and 4-5 months postpartum. Results: At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1\% vs 63.3\%; odds ratio [OR] 2.75, 95\% CI 1.58-4.78; P<.001). Similarly, mothers in the intervention group were more likely to provide predominantly breast milk (OR 2.77, 95\% CI 1.55-4.96; P<.001) and less likely to give dairy products to their children (OR 0.40, 95\% CI 0.21-0.75; P=.005). There was no statistically significant difference for exclusive breastfeeding rate 2-3 months (P=.09) and 4-5 months postpartum (P=.27), though more children in the intervention group were exclusively breastfed than those in the control group 2-3 months postpartum (intervention: 111/152, 73.0\%; control: 96/152, 63.2\%) and 4-5 months postpartum(intervention: 50/108, 46.3\%; control: 46/109, 42.2\%). Conclusions: This study is the first effort to promote exclusive breastfeeding through WeChat in China, which proved to be an effective method of promoting exclusive breastfeeding in early life. WeChat health education can be used in addition to local breastfeeding promotion programs. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017364; http://www.chictr.org.cn/showproj.aspx?proj=29325 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7676-2 ",
doi="10.2196/23273",
url="https://www.jmir.org/2020/12/e23273",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270026"
}


@Article{info:doi/10.2196/21286,
author="Nguyen, T. Tuan
and Weissman, Amy
and Cashin, Jennifer
and Ha, T. Tran
and Zambrano, Paul
and Mathisen, Roger",
title="Assessing the Effectiveness of Policies Relating to Breastfeeding Promotion, Protection, and Support in Southeast Asia: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="21",
volume="9",
number="9",
pages="e21286",
keywords="breastfeeding",
keywords="breast milk substitute",
keywords="Code of Marketing of Breast-milk Substitutes (The Code)",
keywords="maternity protection",
keywords="maternal, infant, and young child nutrition",
keywords="mixed methods study",
keywords="Southeast Asia",
abstract="Background: Despite its well-known benefits, breastfeeding practices remain suboptimal worldwide, including in Southeast Asia. Many countries in the region have thus enacted policies, such as maternity protection and the World Health Assembly International Code of Marketing of Breast-milk Substitutes (the Code), that protect, promote, and support breastfeeding. Yet the impact of such national legislation on breastfeeding practices is not well understood. Objective: This study aims to review the content, implementation, and potential impact of policies relating to maternity protection and the Code in Myanmar, the Philippines, Thailand, and Vietnam. Methods: This mixed methods study includes a desk review, trend and secondary data analyses, and quantitative and qualitative data collection. Desk reviews will examine and compare the contents, implementation strategies, coverage, monitoring, and enforcement of national policies focusing on maternity protection and the Code in each country with global standards. Trend and secondary data analyses will examine the potential impact of these policies on relevant variables such as breast milk substitute (BMS) sales and women's workforce participation. Quantitative data collection and analysis will be conducted to examine relevant stakeholders' and beneficiaries' perceptions about these policies. In each country, we will conduct up to 24 in-depth interviews (IDI) with stakeholders at national and provincial levels and 12 employers or 12 health workers. Per country, we will survey approximately 930 women who are pregnant or have a child aged 0-11 months, of whom approximately 36 will be invited for an IDI; 12 partners of the interviewed mothers or fathers of children from 0-11 months will also be interviewed. Results: This study, funded in June 2018, was approved by the Institutional Review Boards of the relevant organizations (FHI 360: April 16, 2019 and May 18, 2020; and Hanoi University of Public Health: December 6, 2019). The dates of data collection are as follows: Vietnam: November and December 2019, May and June 2020; the Philippines: projected August 2020; Myanmar and Thailand: pending based on permissions and funding. Results are expected to be published in January 2021. As of July 2020, we had enrolled 1150 participants. We will present a comparison of key contents of the policies across countries and against international standards and recommendations and a comparison of implementation strategies, coverage, monitoring, and enforcement across countries. We will also present findings from secondary data and trend data analyses to propose the potential impact of a new or amended policy. For the surveys with women, we will present associations between exposure to maternity protection or BMS promotion on infant and young child feeding practices and their determinants. Findings from IDIs will highlight relevant stakeholders' and beneficiaries' perceptions. Conclusions: This study will increase the understanding of the effectiveness of policy interventions to improve breastfeeding, which will be used to advocate for stronger policy adoption and enforcement in study countries and beyond. International Registered Report Identifier (IRRID): DERR1-10.2196/21286 ",
doi="10.2196/21286",
url="http://www.researchprotocols.org/2020/9/e21286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955449"
}


@Article{info:doi/10.2196/20312,
author="Casilang, G. Clarisse
and Stonbraker, Samantha
and Japa, Ingrid
and Halpern, Mina
and Messina, Luz
and Steenhoff, P. Andrew
and Lowenthal, D. Elizabeth
and Fleisher, Linda",
title="Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic",
journal="JMIR Pediatr Parent",
year="2020",
month="Aug",
day="21",
volume="3",
number="2",
pages="e20312",
keywords="global health",
keywords="breast feeding",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5\% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. Objective: This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ?5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. Methods: Participants were recruited from 3 outpatient sites: the Ni{\~n}os Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Cl{\'i}nica de Familia La Romana and its program M{\'o}dulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. Results: All participants (N=35) reported having a mobile phone, and 29 (83\%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. Conclusions: There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding. ",
doi="10.2196/20312",
url="http://pediatrics.jmir.org/2020/2/e20312/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32821063"
}


@Article{info:doi/10.2196/17361,
author="Almohanna, Ali Alaa
and Win, Than Khin
and Meedya, Shahla",
title="Effectiveness of Internet-Based Electronic Technology Interventions on Breastfeeding Outcomes: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="May",
day="29",
volume="22",
number="5",
pages="e17361",
keywords="breastfeeding",
keywords="mobile app",
keywords="mobile phone",
keywords="mHealth",
keywords="internet",
keywords="computers",
keywords="systematic review",
abstract="Background: Supporting women to initiate and continue breastfeeding is a global challenge. A range of breastfeeding interventions employing electronic technologies (e-technologies) are being developed, which offer different delivery modes and features over the internet; however, the impact of internet-based e-technologies on breastfeeding outcomes remains unclear. Objective: This study aimed to identify the characteristics of current internet-based breastfeeding interventions employing e-technologies and investigate the effects of internet-based e-technologies on breastfeeding outcomes. Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following databases: Scopus, Web of Science, the Cochrane Database of Systematic Reviews, ScienceDirect, Google Scholar, the Association for Computing Machinery, SpringerLink, and Institute of Electrical and Electronics Engineers Xplore. Results: This systematic review included 16 studies published between 2007 and 2018, with 4018 women in 8 countries. The characteristics of the interventions were grouped based on (1) mode of delivery (web-based, mobile phone apps, and computer kiosk), (2) purpose of the interventions (education and support), and (3) key strategies (monitoring and breastfeeding tracking, personalization, online discussion forum, web-based consultation, and breastfeeding station locators). Combining educational activities with web-based personalized support through discussion forums appeared to be the most effective way to improve breastfeeding outcomes and long-term exclusive breastfeeding rates. Monitoring and breastfeeding trackers appeared to be the least effective ways. Conclusions: This study demonstrated a variety of internet-based e-technologies that professionals can use to promote, educate, and support breastfeeding women. Future internet-based breastfeeding interventions employing e-technologies might consider improving interaction with mothers and personalizing the content of the proposed interventions. ",
doi="10.2196/17361",
url="http://www.jmir.org/2020/5/e17361/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32469315"
}


@Article{info:doi/10.2196/17300,
author="Cheng, Heilok
and Tutt, Alison
and Llewellyn, Catherine
and Size, Donna
and Jones, Jennifer
and Taki, Sarah
and Rossiter, Chris
and Denney-Wilson, Elizabeth",
title="Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="27",
volume="8",
number="5",
pages="e17300",
keywords="breast feeding",
keywords="bottle feeding",
keywords="infant food",
keywords="readability",
keywords="consumer health information",
keywords="breastfeeding",
keywords="mobile apps",
keywords="smartphones",
abstract="Background: Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective: This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods: The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results: A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64\% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53\% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps' engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions: The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council's Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources. ",
doi="10.2196/17300",
url="http://mhealth.jmir.org/2020/5/e17300/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459187"
}


@Article{info:doi/10.2196/17328,
author="Demirci, R. Jill
and Suffoletto, Brian
and Doman, Jack
and Glasser, Melissa
and Chang, C. Judy
and Sereika, M. Susan
and Bogen, L. Debra",
title="The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e17328",
keywords="breast feeding",
keywords="perceived insufficient milk",
keywords="text messaging",
keywords="short message service",
keywords="cell phone",
keywords="mobile phone",
keywords="telemedicine",
keywords="mHealth",
keywords="randomized controlled trial",
abstract="Background: Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. Objective: This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)---the single, leading modifiable cause of unintended breastfeeding reduction and cessation. Methods: We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message--based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging--based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. Results: Participants randomized to MILK (87/124, 70.2\% white and 84/124, 67.7\% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3\%) elected to stop MILK messages, and 3 (2.4\%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54\% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants' pre-existing breastfeeding knowledge and unique breastfeeding trajectory. Conclusions: Prenatal and postpartum evidence--based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. Trial Registration: ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969 ",
doi="10.2196/17328",
url="https://mhealth.jmir.org/2020/4/e17328",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347815"
}


@Article{info:doi/10.2196/14355,
author="Skelton, Kara
and Evans, Retta
and LaChenaye, Jenna",
title="Hidden Communities of Practice in Social Media Groups: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2020",
month="Mar",
day="24",
volume="3",
number="1",
pages="e14355",
keywords="online social support",
keywords="breastfeeding",
keywords="social media",
keywords="social support system",
abstract="Background: Although most US mothers initiate breastfeeding, suboptimal breastfeeding rates still exist. Although breastfeeding is a complex process, social support has been linked with increases in positive breastfeeding outcomes. Recent technological advances, including the development of social networking sites, provide mothers with convenient access to a unique array of audiences from which to seek advice about parenting, including breastfeeding. However, little is known about how the use of the sites---specifically groups centered around breastfeeding---influences breastfeeding knowledge, attitudes, or behaviors. Objective: This mixed methods study aimed to explore utilization of an existing probreastfeeding Facebook group and how utilization influences breastfeeding-related knowledge, attitudes, and behaviors. Methods: Participants were recruited online through Facebook wall posts from within the existing group. Mothers aged between 18 and 50 years who were pregnant and intended to breastfeed, were currently breastfeeding, or had recently weaned their infant in the past 3 years were eligible to participate. Participants engaged in online focus group discussions (n=21) and individual interviews (n=12). Inductive content analysis of qualitative data led to the conceptualization and contextualization of a breastfeeding community of practice (COP). Using qualitative results, a quantitative survey was then developed to assess the prevalence of qualities of a COP as well as how COP usage influenced breastfeeding-related attitudes and knowledge. A total of 314 mothers completed the online survey. Results: Qualitative findings showed an overall sense of community, with subthemes of group trust, interaction, and the promotion of breastfeeding. A majority (287/314, 91.5\%) of mothers initiated breastfeeding, with 69.0\% (216/314) of mothers reporting exclusive breastfeeding their infant at 6 months. Approximately 98.5\% (309/314) of mothers reported that the Facebook group captured and stored knowledge; therefore, information could be easily accessed and applied. In addition, 96.2\% (302/317) of mothers reported that the Facebook group motivated them to share breastfeeding-related knowledge. Conclusions: The results suggest that this existing probreastfeeding Facebook group exhibits characteristics of an online COP, which was organically formed. Utilization of the Facebook group, in the context of an online COP, could be beneficial in impacting breastfeeding-related knowledge, attitudes, and behaviors. However, further examination and exploration of breastfeeding COPs, including using this type of model as a method of lactation support or as a telemedicine framework, is a clear need. ",
doi="10.2196/14355",
url="http://pediatrics.jmir.org/2020/1/e14355/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32207693"
}


@Article{info:doi/10.2196/14219,
author="Zhao, Jing
and Li, Mu
and Freeman, Becky",
title="A Baby Formula Designed for Chinese Babies: Content Analysis of Milk Formula Advertisements on Chinese Parenting Apps",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="29",
volume="7",
number="11",
pages="e14219",
keywords="infant formula",
keywords="food policy",
keywords="health promotion",
keywords="marketing",
keywords="mobile app",
keywords="parenting",
keywords="breastfeeding",
keywords="advertisement",
abstract="Background: China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing. Objective: This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding. Methods: We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure. Results: The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure. Conclusions: The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors. ",
doi="10.2196/14219",
url="http://mhealth.jmir.org/2019/11/e14219/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31782743"
}


@Article{info:doi/10.2196/13947,
author="Tang, Kymeng
and Gerling, Kathrin
and Chen, Wei
and Geurts, Luc",
title="Information and Communication Systems to Tackle Barriers to Breastfeeding: Systematic Search and Review",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="27",
volume="21",
number="9",
pages="e13947",
keywords="breastfeeding",
keywords="technology",
keywords="review",
abstract="Background: Breastfeeding has many benefits for newborns, mothers, and the wider society. The World Health Organization recommends mothers to feed newborns exclusively with breastmilk for the first 6 months after birth, but breastfeeding rates in many countries fail to align with the recommendations because of various barriers. Breastfeeding success is associated with a number of determinants, such as self-efficacy, intention to breastfeed, and attitudes toward breastfeeding. Information and communication technology (ICT) has been leveraged to support breastfeeding by means of improving knowledge or providing practical supports in different maternal stages. Previous reviews have examined and summarized the effectiveness and credibility of interventions; however, no review has been done from a human-computer interaction perspective that is concerned with novel interaction techniques and the perspective of end users. Objective: The objective of this review was to provide a comprehensive overview of existing digital interventions that support breastfeeding by investigating systems' objective, technology design, validation process, and quality attributes, both in terms of clinical parameters as well as usability and user experience. Methods: A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following libraries: PubMed, Science Direct, Association for Computing Machinery Digital Library (ACM Digital Library), and Institute of Electrical and Electronics Engineers Xplore (IEEE Xplore). Results: A total of 35 papers discussing 30 interventions were included. The main goals of these interventions were organized into 4 categories: breastfeeding education (n=12), breastfeeding promotion (n=8), communication support (n=6), and daily practical support (n=4). Of the interventions, 13 target mothers in the postnatal period. Most interventions come in forms of client communication systems (n=18), which frequently leverage Web technologies, text message, and mobile apps to provide breastfeeding support. Systems predominantly focus on mothers; validation strategies were rather heterogeneous, with 12 user studies concerning usability and user experience and 18 clinical validation studies focusing on the effects of the interventions on breastfeeding determinants; 5 papers did not report results. Generally, straightforward systems (eg, communication tools or Web-based solutions) seem to be more effective than complex interventions (eg, games). Conclusions: Existing information and communication systems offer effective means of improving breastfeeding outcomes, but they do not address all relevant periods in parenthood (eg, the antenatal period) and often do not involve important stakeholders, such as partners. There is an opportunity to leverage more complex technical systems to open up avenues for the broader design of ICT to support breastfeeding; however, considering evaluation outcomes of existing support systems of higher complexity, such systems need to be designed with care. ",
doi="10.2196/13947",
url="https://www.jmir.org/2019/9/e13947/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573903"
}


@Article{info:doi/10.2196/13967,
author="Kapinos, Kandice
and Kotzias, Virginia
and Bogen, Debra
and Ray, Kristin
and Demirci, Jill
and Rigas, Ann Mary
and Uscher-Pines, Lori",
title="The Use of and Experiences With Telelactation Among Rural Breastfeeding Mothers: Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="03",
volume="21",
number="9",
pages="e13967",
keywords="telehealth",
keywords="telemedicine",
keywords="breastfeeding",
keywords="lactation",
keywords="lactation support",
keywords="rural health",
abstract="Background: Telelactation services connect breastfeeding mothers to remotely located lactation consultants through audio-visual technology and can increase access to professional breastfeeding support in rural areas. Objective: The objective of this study was to identify maternal characteristics associated with the demand for and use of telelactation and to describe visit characteristics. Methods: We conducted a descriptive study within the context of a randomized controlled trial. Participant survey data and vendor electronic medical record data were used to assess video call characteristics like timing, duration, topics discussed, and participant satisfaction. Recruitment occurred from 2016-2018 at a rural critical access hospital in Pennsylvania. The 102 women enrolled in the study were given access to unlimited, on-demand video calls with lactation consultants through a mobile phone app and were tracked for 12 weeks following their postpartum hospitalization. Results: A total of 94 participants out of 102 recruits (92\%) participated in the final, 12-week survey assessment were included in the analysis. Of those, 47 (50\%) participants reported participating in one or more video calls, and 31 (33\%) completed one or more calls that included a substantive discussion of a breastfeeding challenge. Participants who used telelactation (21/31, 68\%; P=.02) were more likely to be working at 12 weeks postpartum compared to others (26/63, 41\%), were less likely (12/31, 39\%; P=.02) to have prior breastfeeding experience on average compared to nonusers (41/63, 65\%), and were less likely to have breastfed exclusively (16/31, 52\%; P<.001) prior to hospital discharge compared to mothers who didn't use telelactation services (51/63, 81\%). Most video calls (58/83, 70\%) occurred during the infant's first month of life and 41\% (34/83) occurred outside of business hours. The most common challenges discussed included: breast pain, soreness, and infection (25/83, 30\%), use of nipple shields (21/83, 25\%), and latch or positioning (17/83, 24\%). Most telelactation users (43/47, 91\%) expressed satisfaction with the help received. Conclusions: Telelactation is an innovation in the delivery of professional breastfeeding support. This research documents both demand for and positive experiences with telelactation in an underserved population. Trial Registration: ClinicalTrials.gov NCT02870413; https://clinicaltrials.gov/ct2/show/NCT02870413 ",
doi="10.2196/13967",
url="https://www.jmir.org/2019/9/e13967/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31482848"
}


@Article{info:doi/10.2196/12157,
author="White, Becky
and Giglia, C. Roslyn
and White, A. James
and Dhaliwal, Satvinder
and Burns, K. Sharyn
and Scott, A. Jane",
title="Gamifying Breastfeeding for Fathers: Process Evaluation of the Milk Man Mobile App",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="20",
volume="2",
number="1",
pages="e12157",
keywords="mHealth",
keywords="app",
keywords="breastfeeding",
keywords="fathers",
keywords="gamification",
keywords="socially connected",
keywords="push notifications",
abstract="Background: Mobile technology offers unique opportunities to reach people with health promotion interventions. Breastfeeding is an important public health issue, and fathers are a key support. Milk Man is a father-focused breastfeeding app that sought to engage fathers with information and conversation about breastfeeding, with the goal to impact positively on breastfeeding duration. Objective: The study aimed to describe the process evaluation of the Milk Man app that was trialed in the Parent Infant Feeding Initiative randomized controlled trial. Methods: The app used an information library, gamification, push notifications, and social connectivity via a Web-based conversation forum, which included polls and conversation starters, to engage fathers with breastfeeding information. Fathers had access to the app from approximately 32 weeks of gestation to 6 months postpartum. Process evaluation data were collected from a self-completed questionnaire administered via a Web-based link sent to participants at 6 weeks postpartum, and app analytics data were collected directly from the app. Quantitative data from both sources and qualitative responses to open-ended questions were used to triangulate findings to investigate patterns of usage and the effectiveness of each app engagement strategy to motivate and engage users. Results: A total of 80.3\% (586/730) of participants, who were randomized to receive the app, downloaded Milk Man. Push notifications and interest in what other fathers had posted in the forum were the 2 main motivators to app use. Fathers used the app most while their partners were still pregnant and in the weeks immediately after the birth of their baby. Perspectives on the gamification strategy were varied. However, at 6 weeks postpartum, approximately one-third of fathers still using the app said that the gamification elements were encouraging the app use. The ease of use of the app and the design were important elements that were rated positively. The conversation forum emerged as the hub of app activity; all but 1 of the most accessed library articles and external organization links had been prompted as part of a conversation starter. Fathers posted comments in the conversation forum 1126 times (average of 2.21 per user) and voted in polls 3096 times (average of 6 per user). Conclusions: These results demonstrate that the Milk Man app was an acceptable source of breastfeeding information and support that fathers and fathers-to-be are prepared to use throughout the perinatal period. The app showed encouraging results with facilitating conversation between partners. The conversation forum was clearly central to the success of the app, and fathers provided suggestions for improvement. Gamification results were varied, yet it was a key motivator for some users. These results provide valuable insight into the acceptability of the engagement strategies, including motivations for use and user perspectives on the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695;?https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?ACTRN=12614000605695? ",
doi="10.2196/12157",
url="http://pediatrics.jmir.org/2019/1/e12157/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518324"
}


@Article{info:doi/10.2196/12364,
author="Sidhu, Suhail
and Ma, Kaoer
and Sadovnikova, Anna",
title="Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory",
journal="JMIR Pediatr Parent",
year="2019",
month="May",
day="01",
volume="2",
number="1",
pages="e12364",
keywords="milk production",
keywords="milk supply",
keywords="human lactation",
keywords="breastfeeding",
keywords="breastfeeding app",
keywords="smartphone app",
keywords="Social Cognitive Theory",
keywords="breastfeeding self-efficacy",
abstract="Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production. Objective: The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production. Methods: Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience. Results: Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5\% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively. Conclusions: Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery. ",
doi="10.2196/12364",
url="http://pediatrics.jmir.org/2019/1/e12364/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518317"
}


@Article{info:doi/10.2196/11344,
author="Skelton, Renee Kara
and Evans, Retta
and LaChenaye, Jenna
and Amsbary, Jonathan
and Wingate, Martha
and Talbott, Laura",
title="Exploring Social Media Group Use Among Breastfeeding Mothers: Qualitative Analysis",
journal="JMIR Pediatr Parent",
year="2018",
month="Nov",
day="05",
volume="1",
number="2",
pages="e11344",
keywords="social media",
keywords="milk",
keywords="human",
keywords="breastfeeding",
abstract="Background: Breastfeeding is well known as the optimal source of nutrition for the first year of life. However, suboptimal exclusively breastfeeding rates in the United States are still prevalent. Given the extent of social media use and the accessibility of this type of peer-to-peer support, the role of social networking sites in enabling and supporting breastfeeding mothers needs to be further explored. Objective: This study aimed to leverage mothers' attitudes and behaviors of social media usage to understand effects on breastfeeding outcomes. Methods: Participants were recruited from 1 probreastfeeding social media group with over 6300 members throughout the United States. Online focus group discussions were conducted with 21 women; interviews were conducted with 12 mothers. Qualitative data were aggregated for thematic analysis. Results: Participants indicated that the social media group formed a community of support for breastfeeding, with normalizing breastfeeding, empowerment for breastfeeding, resource for breastfeeding, and shared experiences in breastfeeding as additional themes. Conclusions: According to participants, social media groups can positively influence breastfeeding-related attitudes, knowledge, and behaviors as well as lead to longer duration of breastfeeding. The results of this study should be taken into account when designing interventions for breastfeeding mothers. ",
doi="10.2196/11344",
url="http://pediatrics.jmir.org/2018/2/e11344/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518305"
}


@Article{info:doi/10.2196/11039,
author="Jiang, Hong
and Li, Mu
and Wen, Ming Li
and Baur, A. Louise
and He, Gengsheng
and Ma, Xiaoying
and Qian, Xu",
title="A Short Message Service Intervention for Improving Infant Feeding Practices in Shanghai, China: Planning, Implementation, and Process Evaluation",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="29",
volume="6",
number="10",
pages="e11039",
keywords="mHealth",
keywords="short message service",
keywords="breastfeeding",
keywords="infant feeding practices",
keywords="health services",
keywords="planning and development",
keywords="implementation",
keywords="process evaluation",
abstract="Background: Although mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. Objective: Our study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. Methods: The intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. Results: We found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. Conclusions: This study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited. ",
doi="10.2196/11039",
url="http://mhealth.jmir.org/2018/10/e11039/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30373728"
}