Designing and Developing A Mobile App (BeBo) in a Randomized Controlled Trial Study to Promote Breastfeeding Among Vietnamese mothers: A Mixed-Methods Study (Preprint)
Authors: Doan Thi Thuy Duong , Tran Chuyen Trung , Pham Minh Ngoc , Zhao Yun , Dinh Hoa Thi Phuong , Nguyen Hoai Xuan , Lee Andy , Binns Colin , Bui Ha Thi Thu 
Published: December 2020

BACKGROUND

Breastfeeding has substantial benefits for both mothers and children. The World Health Organization and the Vietnam Ministry of Health recommend exclusive breastfeeding for 6 months. However, this target was reached by fewer than 17% of Vietnamese infants. and in urban areas such as Hanoi, was only about 12.6%. Many factors influence breastfeeding, but mothers are the most influential in achieving breastfeeding success. The high rate of use of smart mobile phones among mothers in urban areas offers unique opportunities to promote breastfeeding.

OBJECTIVE

This study aimed to document the process of designing, developing, and evaluating a mobile app that is tailored to Vietnamese culture and aims to increase breastfeeding rates, particularly exclusive breastfeeding, and duration in Vietnamese women.

METHODS

To design and develop the mobile app we used 4-step mixed methods approach with formative research, testing, and iterations. We firstly reviewed studies using mHealth and mobile apps for improving breastfeeding as well as barriers and facilitators of breastfeeding in Vietnam. We then conducted 22 in-depth interviews with mothers about key barriers, facilitators, and ideas about the apps. Self-administered online questionnaires were responded to by 49 mothers and fathers about the main features and contents of the apps. After that, we identified the main themes and research team developed the app. In the next step, we tested the app messages with mothers of 3 focus groups and invited external experts to review the library content. Finally, our team members tested and adjusted the prototype before conducting a large-scale test of its effectiveness.

RESULTS

Participants were most interested in information on the mental health and wellbeing of mothers during pregnancy and after delivery, preparation for delivery, and avoiding food and beverages. Regarding breastfeeding, mothers were most concerned about nutrition for mothers during breastfeeding, preventing and reducing difficulties on breastfeeding, and initiation of breastfeeding. Three key features to be included in the prototype app were identified from the formative research: (1) notifications; (2) an information library; and (3) searching function. The app should be installed during pregnancy rather than after delivery (81% vs 17%, respectively). Push notifications that convey the main messages should be sent 2 – 3 times per week to remind mothers to use the app (33%). Two versions of the app and a mechanism that ensured a triple-blinded, randomized controlled trial study were developed.

CONCLUSIONS

The development of the app, called BeBo, followed a best practice approach, including the involvement of related stakeholders and grounding in behavior change theory. To the best of our knowledge, it is the first mobile app that enables us to evaluate the effectiveness of mHealth interventions in a well-conducted randomized controlled trial. BeBo is currently being trialed as part of a randomized controlled trial study (ACTRN12619000531112).

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