JMIR Publications

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 was a father-focused breastfeeding app, that sought to engage fathers with information and conversation about breastfeeding.

Objective:

This paper describes the process evaluation of the Milk Man mobile app investigating patterns of use and identifies which of the app engagement strategies were effective in motivating and engaging users.

Methods:

The Milk Man app used an information library, gamification, push notifications and social connectivity, which included polls and conversation starters, to engage fathers with breastfeeding information. Fathers had access to the app from approximately 32 weeks gestation to 6 months postpartum. The study used a mixed methods approach to data collection and analysis. Data were collected from a self-completed questionnaire administered at 6 weeks postpartum and the app analytics framework. Both qualitative and quantitative data analysis methods were used to triangulate data to evaluate implementation outcomes.

Results:

A total of 86% (586/681) of participants who were randomised into an app group, downloaded Milk Man. Push notifications and interest in what other fathers had posted in the forum were the two 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, about a third of fathers still using the app said that the gamification elements were actively encouraging use. The ease of use of the app, and the design were important elements that rated positively. The conversation forum emerged as the hub of app activity; all but one 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 (avg. 2.21 per user) and voted in polls 3096 times (avg. 6 per user). Over half of fathers (54%) said the information in the app had led to a discussion with their partner. This was more apparent for those participants who used the app for longer than 6 weeks.

Conclusions:

These results demonstrate that the Milk Man app was an acceptable approach 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 on how this could be improved. 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. Clinical Trial: The Milk Man app was developed to be trialled in the Parent Infant Feeding Initiative (PIFI) RCT (ACTRN12614000605695)