JMIR Publications

ABSTRACT

Background:

Despite growing interest in the use of technology to improve health outcomes and health care delivery in low- and middle-income countries (LMIC), local attitudes towards mHealth use in these settings are minimally understood. This is especially true in the Dominican Republic, where attitudes toward mHealth have not been fully assessed. Yet, this information is critical for developing effective mHealth interventions to address public health problems, such as low rates of exclusive breastfeeding (EBF), which can lead to poor infant outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic (DR) has one of the lowest EBF rates worldwide.

Objective:

This study aimed to describe the current use of information and communication technologies (ICT) and to analyze the attitudes and perceptions related to using cellular phones for mobile health (mHealth) interventions among caregivers of children ≤5 years old and health promoters in the DR. Findings can inform mHealth strategies aiming to improve EBF in this, and other, LMICs.

Methods:

Participants were recruited from three outpatient sites: the Niños Primeros en Salud program based at Centro de Salud Divina Providencia in Consuelo (rural setting), Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers of infants and community health promoters to identify use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by a semi-structured interview guide. All sessions were audio recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes.

Results:

All participants (n=35) reported having a cellular phone and 29 (83%) had smartphone technology. Sources for obtaining health information included internet, physician/clinic, family/friends, health promoters, and television. Barriers to mHealth use included cost of internet service, privacy concerns, and perceived credibility of sources. Participants indicated desire for, and willingness to use, a mHealth intervention to support breastfeeding. Desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images/video content, text messages and person-to-person interaction, as well as notifications for appointments/vaccines/feeding schedule. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding.

Conclusions:

There is a high level of acceptance for ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create a meaningful and useful intervention. Participants wanted to receive trusted, reliable information through various formats and were interested in information beyond breastfeeding.