P0336 - Mother’s Milk Messaging™ (MMM): Mixed Methods Evaluation of Bilingual App and Texting Program to Support Breastfeeding (BF)

Background: Breastfeeding (BF) provides optimal health benefits for mothers and their infants. Most new mothers experience BF challenges but evidence-based support online and through mobile apps is limited. We developed and evaluated an app (MMM) in English and Spanish to help mothers from late third trimester through 2 months postpartum meet their BF goals.

Objective: 1. To describe engagement with and usage of the app.
2. To measure efficacy (changes in attitudes, confidence, and perceived social supports) with regards to BF from baseline to the 3-month follow-up.
3. To determine if using the app improved BF rates.
Design/

Methods: We recruited online a national sample of primiparous, singleton mothers with uncomplicated pregnancy, interested in BF, through ads and listservs. We randomized the mothers to one of three arms: 1) BF text messages plus app access; 2) BF text messages, app access, and physician-moderated private Facebook (FB) group; and 3) Attention control group who received injury prevention texts not related to BF. We determined engagement through analysis of app usage metrics. We conducted and content coded using Atlas Ti 60 qualitative interviews with participants to learn more about app usage and BF experience. Attitude, confidence, social support and BF outcomes were determined from comparing baseline and 3-month post-intervention responses to a survey with validated questions. We combined 2 intervention arms because of minimal FB activity and similar outcomes.

Results: Total participants included n= 311 with the Intervention n=201 and Control n=110. Demographics are shown in Table 1. Greater than 80% registered the app, 40% interacted with the app on some level with greater app use after baby's birth. Mothers reported positively to receiving text messages and to reliability of information. Discontinuation of app use was common among mothers reporting early problems and no problems with BF. Women in the intervention arm reported significantly higher confidence and social support compared to the control group. Outcomes are shown in Table 2.
Conclusion(s): Highly motivated, white married women were the highest utilizers of the new MMM app despite a national online recruitment mode and the bilingual and culturally enhanced option. We were surprised that the FB group participants engaged minimally online and did not ask for help in that forum. Further study closely linking MMM app with a personal contact through WIC counselor or medical provider may improve engagement and outcomes.