JMIR Publications

ABSTRACT

Background:

Breastfeeding rates among U.S. mothers, particularly Black/African American mothers, fall short of recommended guidelines. Despite benefits of human milk, only 24.9% of all infants receive human milk exclusively at 6 months.

Objective:

Our team previously explored the key content areas an mHealth intervention should address and usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app intervention guided by the preferences of Black/African American parents. This study aims to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Defining elements of social branding to guide app development as a trusted advisor were sought. The study also aimed to validate previous findings regarding approach to supporting breastfeeding goals and cultural tailoring.

Methods:

We conducted a qualitative study using in-depth interviews and two focus groups with potential KULEA-NET users A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. Data methods followed qualitative research principles and stopped when saturation was achieved. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, one with expertise in social branding and one certified in lactation, participated in thematic analysis.

Results:

All participants identified as Black/African American mothers and a majority of interview participants engaged in exclusive breastfeeding (57%). Four themes were recognized. One, participants identified desired content, specifying peer and support, facilitated access to experts, geolocation to identify resources, and tracking functions. Two, delivery of content differentiated platforms and messaging modality. Three, functionality and features distinguished content diversity, ease of use, credibility, and interactivity as salient. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in online forums and virtual or in-person support groups to help balance the ideal medical recommendations for infant feeding with contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility.

Conclusions:

This formative research suggested additional elements for an expanded KULEA-NET app are beneficial and desired. A health branding approach to establish KULEA-NET as a trusted advisor is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial. Clinical Trial: The study has been registered under clinicaltrials.gov [clinicaltrials.gov] ClinicalTrials.gov ID NCT059858762.