JMIR Publications

ABSTRACT

Background:

Breastfeeding plays a major role in the health of mothers and babies and has the potential to positively shape an individual’s life both in the short and long-term. In the United Kingdom (UK), despite 81% of women initiating breastfeeding, only 1% of women breastfeed exclusively to six months as recommended by the World Health Organisation (WHO). In the UK, women who are socially disadvantaged and younger, are less likely to breastfeed at 6-8 weeks postpartum. One strategy that aims to improve these statistics is the Baby Buddy app which has been designed, developed and implemented by the UK charity Best Beginnings to be a universal intervention to help reduce health inequalities, including breastfeeding.

Objective:

Our study retrospectively examined the development of Baby Buddy applying the Behaviour Change Wheel (BCW) framework to understand how it might increase breastfeeding self-efficacy, knowledge and confidence.

Methods:

Retrospective application of the Behaviour Change Wheel (BCW) was completed after the app was developed and embedded into maternity services. A three-stage process evaluation used triangulation methods and formalised tools to gain an understanding of the potential mechanisms and behaviours used in apps that are needed to improve breastfeeding rates in the UK. Firstly, we generated a behavioural analysis by mapping breastfeeding barriers and enablers onto the Capability, Opportunity and Motivation-Behaviour (COM-B) system using documents provided by Best Beginnings. Secondly, we identified the intervention functions and policy categories used, then in the third stage, we linked these with the behaviour change techniques identified in the app breastfeeding content using the Behaviour Change Techniques Taxonomy (BCTTv1).

Results:

Baby Buddy is a well-designed platform that could be used to change breastfeeding behaviours. Findings from stage one showed that Best Beginnings had defined breastfeeding as a key behaviour requiring support, demonstrated a thorough understanding of the context in which breastfeeding occurs, barriers and enablers and the target actions needed to support breastfeeding. In stage two, we found evidence that Best Beginnings had used intervention and policy functions to address barriers and enablers to breastfeeding. In stage 3 we found evidence that Baby Buddy had also been assessed for acceptability, practicability, effectiveness, affordability, safety and equity. Several Behaviour Change Techniques (BCTs) that could assist women with decision making around breastfeeding (e.g. information about health consequences and credible sources) and possibly affect attitudes and self-efficacy were identified.

Conclusions:

Applying a theoretical framework retrospectively to a mobile app is possible and results in useful information to understand potential health benefits and to inform future development. Future research should assess which components and behavioural techniques in the app are most effective in changing behaviour and supporting breastfeeding.