Effectiveness of a mobile breastfeeding monitoring tool on breastfeeding exclusivity and self-efficacy: a per-protocol analysis of a randomized trial (Preprint)
Authors: Jia Ni , Schensul Jean J. , Zhang Meixian , Kong Lianfang , Yan Qi , Dai Yaohua 
Published: October 2024

BACKGROUND

Globally, the pursuit of exclusive breastfeeding remains a formidable challenge. The surge in popularity of mHealth interventions has swiftly emerged as a promising avenue for promoting breastfeeding practices. Nevertheless, research investigating breastfeeding monitoring interventions via mHealth remains scarce.

OBJECTIVE

This study aimed to use an application (app) called "Breastfeeding Aiding Tool" to monitor breastfeeding and provide feedback as a remote intervention to improve breastfeeding exclusivity and maternal breastfeeding self-efficacy.

METHODS

This study embarked on a randomized controlled trial, leveraging an innovative app called "Breastfeeding Aiding Tool" as the intervention to monitor breastfeeding practice recorded by users and provide feedback automatedly facilitating remote education and consultation by health workers that enhanced breastfeeding exclusivity and maternal breastfeeding self-efficacy. Lactating mothers and their healthy primiparous infants aged 35-49 days were enrolled from clinics, and the on-line follow-up period was 2 months. Breastfeeding practices, maternal breastfeeding confidence assessed by the Breastfeeding Self-Efficacy Scale-Short Form and maternal depression status assessed by the Center for Epidemiological Survey Depression Scale were collected based on self-report through SoJump.

RESULTS

109 mother-infant dyads (55 in the intervention group and 54 in the control group) completed the 2-month follow-ups and 28 mothers actively engaged with the app tool. In the per-protocol analysis sample, the rate of exclusive breastfeeding of the using-tool group stood at 57.1%, compared to 48.2% in the comparison (Odds Ratio (OR)=1.44 (95% CI: 0.60,3.41); adjusted OR(aOR)=1.68 (95% CI: 0.60,4.70); p>0.05); the rate of full breastfeeding (comprising predominant and exclusive breastfeeding) was significantly higher in the mothers using the app tool than in the non-users (92.9% vs. 72.8%; OR=4.85 (95%CI: 1.06,22.15); aOR=6.96 (95%CI: 1.28,37.90); p<0.05). Furthermore, maternal breastfeeding self-efficacy in the app-use group improved by 1.36 (95%CI: -3.79,1.50), while it declined slightly by 0.16 (95%CI: -3.16,2.84) (p>0.05) in the non-users. The depression scores among the mothers using the app decreased by 2.29 (95%CI: -5.19,0.62), whereas those in the non-using group increased by 1.07(95%CI: -0.58,2.73) (p<0.05).

CONCLUSIONS

Our findings underscore the significant potential of the "Breastfeeding Aiding Tool" app as an aiding tool for breastfeeding guiding in sustaining breastfeeding practices, reducing formula usage, and enhancing maternal breastfeeding emotions. To further validate the effectiveness of improving breastfeeding exclusivity and self-efficacy, studies should endeavor to enroll a larger cohort of mothers utilizing the app.

CLINICALTRIAL

The intervention study was registered in the Chinese Clinical Trial Registry (ChiCTR2200065220).