JMIR Publications

ABSTRACT

Background:

Breastfeeding has many benefits for newborns, mothers, and wider society. WHO recommends mothers to feed newborns exclusively with breastmilk for the first six months after birth but breastfeeding rates in many countries fail to align with the recommendations due to 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. Prior 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:

This review aims to provide a comprehensive overview of existing digital interventions to support breastfeeding to digital intervention researchers 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 PRISMA guidelines in the following libraries: PubMed, Science Direct, ACM and IEEE.

Results:

Thirty-five papers discussing 30 interventions were included. The main goals of these interventions were organized to four categories: 1) breastfeeding education (n=12), 2) breastfeeding promotion (n=8), 3) communication support (n=6), and 4) daily practical support (n=4). Thirteen of the interventions target mothers in the postnatal period. Most interventions come in forms of client communication systems (n=18) which frequently leverage web technologies, short text message (SMS) and mobile apps to provide breastfeeding support. Systems predominantly focus on mothers; validation strategies were rather heterogeneous with 12 user studies concerned usability and user experience, and 18 clinical validation studies focused on the effects of the interventions on breastfeeding determinants; five papers did not report results. Generally, straightforward systems (e.g., communication tools or web-based solutions) seem to be more effective than complex interventions (e.g., games).

Conclusions:

Existing information and communication systems offer effective means of improving breastfeeding outcomes, but do not address all relevant periods in parenthood (e.g., the antenatal period), and often does 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 information and communication technology to support breastfeeding, however, considering evaluation outcomes of existing support systems of higher complexity, such systems need to be designed with care.