Mother's Milk Messaging: Evaluation of a Bilingual Application (APP) to Support Initiation and Exclusive Breastfeeding in New Mothers
Condition: Breastfeeding
Study type: Interventional

Summary: 
      This study is being conducted to evaluate the breastfeeding support program utilizing
      bilingual English-Spanish tailored text messages and online support to support exclusive and
      continuous breastfeeding for new mothers--comparing texting alone, texting with an online
      support group to those with usual care. The cost involved in moderating the online groups and
      providing bidirectional consultation when needed will be evaluated and qualitative feedback
      from a subset of mothers in both intervention groups will be evaluated to determine what was
      effective, as well as suggestions for improvement of the messaging program.
    

Detailed description: 
      Women of child-bearing age are in the generation most likely to use texting to communicate,
      and most own a cellular phone, and that cell phones have been demonstrated to be efficacious
      in increasing Human Immunodeficiency Virus (HIV) medication compliance and smoking cessation,
      and in improving diabetes management, the investigators consider this may be a promising
      strategy to increase breastfeeding. The investigators developed theoretically-based text
      message content along with breast feeding informational and video content designed for
      delivery via closed private groups on social media based on formative work and then conducted
      a pilot study to text the effects of interactive messaging sent over a 12 week period (i.e. 6
      weeks prior and after birth) that targeted barriers (e.g. insufficient milk, pain/sore
      nipples, breastfeeding in public, among others) on exclusivity and continuation of
      breastfeeding. The investigators innovative approach, called Mother's Milk Messaging (MMM)
      specifically targets low-income and minority mothers and has the potential to reach
      unprecedented numbers of mothers, to be standardized for later scalability, and to be
      cost-effective.

      While Text4Baby texting application uses a similar approach, the text messages are not
      interactive and they do not address specific issues with breastfeeding. The device's social
      media content facilitates private, peer and expert support for breastfeeding in real time on
      a channel preferred by first time mothers.

      Applying a theoretically-based framework, the investigators developed content stemming from
      Dr. Maya Bunik's previous published Breastfeeding Telephone Triage and Advice. Content was
      adapted for delivery via a mobile application (App) with attention to an Integrated Theory of
      mobile Health (mHealth) using best practices for app design for health promotion using social
      and mobile technology. The content was modified to facilitate engagement with content using
      technology, utilizing communication theories such as Gain and Loss Framing and Elaboration
      theory, and theories to support social networking and social support, along with behavioral
      health theories such as the Theory of Planned Behavior and Social Cognitive Theory.

      The MMM app has three main elements: text messages via push notification are stored and
      searchable on the app, access to a breastfeeding social support group on Facebook, and access
      to videos and written material to facilitate knowledge acquisition and skills building. The
      text messages are targeted at specific theoretical constructs such as outcome
      expectations/attitudes, barrier self-efficacy, reinforcing a message using peripheral
      (expert) opinion, eliciting a sense of social currency or providing a cue-to-action. The
      breastfeeding social support group on Facebook will be moderated to facilitate posting of
      shared experiences. Short videos, photographs, and written blurbs on related topics are
      posted on the Facebook page to reinforce the messaging and content of the texts. After a
      successful pilot study of MMM the investigators are ready to test the benefits of supporting
      new mothers with breastfeeding using the investigators bilingual mobile phone application
      (app) and online support program.
    

Intervention name(s): Social Support Group (Facebook); Breastfeeding messages; Injury Prevention Messages
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The breastfeeding social support group on Facebook will be moderated to facilitate posting of shared experiences. Short videos, photographs, and written blurbs on related topics are posted on the Facebook page to reinforce the messaging and content of the texts.; The Mother's Milk Messaging app gives participants access to text messages via push notification on the app, as well as access to videos and written material to facilitate knowledge acquisition and skills building. The text messages are targeted at specific theoretical constructs such as outcome expectations/attitudes, barrier self-efficacy, reinforcing a message using peripheral (expert) opinion, eliciting a sense of social currency or providing a cue-to-action.; The Mother's Milk Messaging app will provide participants in the control group with genetic injury prevention message.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research