45: Impact of a novel smartphone application on low-income women’s breastfeeding rates: a randomized controlled trial

Abstract

Low-income women are less likely to exclusively breastfeed on postpartum day 2 (PPD2) versus high-income women but suggested in focus groups that on-demand video on breastfeeding and normal infant behavior would help. Because smartphone applications (apps) provide on-demand video, we aimed to determine whether a novel app—BreastFeeding Friend (BFF)— impacts breastfeeding rates for low-income women. This RCT included nulliparous, low-income English-speaking women at 36 weeks gestation. Consenting women received an android phone and 3 months of prepaid internet service before being randomized to BFF or a skeleton app. BFF was created with lactation consultants and refined by focus groups of pregnant low-income women to provide optimal tech-based lactation and postpartum support. The skeleton app contained digital breastfeeding handouts. Our primary outcome was exclusive breastfeeding at PPD2; secondary outcomes were breastfeeding rates until 6 months postpartum and reported best breastfeeding resource. Assuming baseline exclusive breastfeeding rates on PPD2 of 34%, a sample size of 85 women per arm would afford 80% power to detect 65% increase in exclusive breastfeeding on PPD2 for BFF while accounting for loss-to-follow-up. 170 women enrolled; 169 had outcomes (99.4%). Exclusive breastfeeding on PPD2 was similar among BFF users versus skeleton app users (36.6% (n=30) vs 35.7% (n=30); p=0.9). Breastfeeding rates until six months postpartum were similar. Though BFF users were less likely to introduce formula on day of delivery, overall, formula was introduced at similar age. BFF users were more likely to report an app provided the best breastfeeding support at 6 weeks postpartum (n=34 (52.3%) vs n=20 (31.3%); p=0.03); approximately one third of women in each group did so at 6 months postpartum. BFF did not improve breastfeeding rates despite patient perception that it was the best breastfeeding resource after hospital discharge. Further optimizing BFF with end-user feedback may translate app favorability into improved clinical outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)