JMIR Publications

ABSTRACT

Background:

The health benefits of breastfeeding for both infants and parents are well-established, yet global breastfeeding rates remain below recommended levels. Parent-targeted Digital Health Interventions (DHIs), including mobile health (mHealth) and electronic health (eHealth) strategies, offer a scalable way to support breastfeeding, but their effectiveness remains uncertain.

Objective:

To explore the effectiveness of parent-targeted DHIs for improving breastfeeding outcomes.

Methods:

Seven databases (CENTRAL, CINAHL, Education Research Complete, Embase, MEDLINE, PsycINFO and Scopus) were searched on April 15, 2024, for randomised controlled trials (RCTs) involving parents of children aged under five years. Eligible interventions aimed to promote breastfeeding and were primarily delivered via digital platforms (e.g. mobile apps, text messaging and websites). Studies were excluded if the DHI exclusively targeted breastfeeding within clinical settings or focused on non-digital content. Outcomes of interest included exclusive breastfeeding, any breastfeeding, breastfeeding duration, breastfeeding self-efficacy, cost-effectiveness and adverse events. Risk of bias of the primary outcome was assessed using the Cochrane Risk of Bias 2 (RoB2) tool. Meta-analyses were conducted in accordance with Cochrane methods and result are reported following PRISMA guidelines.

Results:

Thirty-one (29 RCTs and 2 cluster-RCT) studies, including 14776 participants from 17 diverse countries were included. Nineteen of the interventions focused on mHealth strategies, nine were delivered online and five were telecommunication interventions. Risk of bias was indicated with ‘some concerns’ or ‘high risk’ for 26 (84%) studies. Pooled results indicated that DHIs can significantly improve the odds of exclusive breastfeeding (OR: 2.35, 95% CI: 1.71 to 3.23, I2=81%; 26 trials, 9884 participants), however considerable heterogeneity was present. Pooled results also indicated DHIs may improve breastfeeding duration (SMD: 0.50, 95% CI: 0.30 to 0.69, I2=15%, 5 trials, 601 participants), and ‘any’ breastfeeding (OR: 1.16, 95% CI: 0.99 to 1.35, I2=7%, 14 trials, 7974 participants).

Conclusions:

Improvements to exclusive breastfeeding rates and breastfeeding duration are linked to major societal and health benefits for infants and mothers. Our results indicate that parent-targeted DHIs are effective for improving key breastfeeding behaviours, with evidence of their impact spanning diverse populations and contexts. Clinical Trial: PROSPERO (CRD42023492644)