Lactation Advice Through Texting Can Help (LATCH): An Analysis of Intensity of Engagement via Two‐Way Text Messaging

Abstract

Rates of breastfeeding initiation and duration among women who attend the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are dramatically lower than non‐participants. Innovative solutions are needed to improve breastfeeding rates in this population. The LATCH study was one such approach, designed to augment and reinforce the WIC breastfeeding peer counseling process. The purpose of this study was to examine intensity of engagement via two‐way text messaging in a sample of women attending the WIC breastfeeding peer counseling program and enrolled in LATCH. The objectives were to: (1) Describe intensity of text message engagement in the context of LATCH; and (2) Assess the association between intensity of engagement and exclusive breastfeeding status. Text messaging data were first coded qualitatively by two independent researchers and intensity of engagement variables created. An analysis of intensity of engagement was conducted using descriptive statistics for normally distributed data and binary logistic regression.Participants (N = 70) were on average 26.8 years old (SD = 5.0; range: 18 – 41) with an average pre‐pregnancy weight of 158.1 pounds (SD = 46.8) and average body mass index of 28.0 (SD = 6.7), which falls in the overweight range. The average gestational age at recruitment was 23.4 weeks (SD = 3.2; range: 14 – 28). Nearly three‐quarters of the sample self‐identified as Hispanic, more than two‐thirds were single‐never married, more than three‐quarters were living with their partner, 65.7% had other children at home, 61.2% spoke English primarily, and 40.0% had more than a high school education. More than half of participants (55.2%) had previous breastfeeding experience and of those who had other children at home (n=46), just 8 had no previous breastfeeding experience.A larger volume of one‐ and two‐way SMS exchanges and MMS clicks occurred during the prenatal period. However, only post partum intensity of engagement was significantly associated with breastfeeding status at two weeks such that those who were exclusively breastfeeding averaged 1.26 more two‐way exchanges compared to the partial/no breastfeeding women (p = 0.037). The average number of breastfeeding issues addressed by BFPC's in the post partum period was significantly associated with breastfeeding status. Those who were exclusively breastfeeding had an average of 1.31 more breastfeeding issues addressed than partial/no breastfeeding women (p =0.008). In the multivariable model, controlling for baby's age at the time of the two week interview, onset of lactation, mother's age, parity, pre‐pregnancy BMI, and infant feeding intentions, the number of breastfeeding issues addressed during the first two weeks post partum was the single strongest predictor of exclusive breastfeeding status [OR = 1.69; 95% CI (1.12, 2.57)]. Pre pregnancy BMI also significantly predicted exclusive breastfeeding status [OR: 0.88; 95% CI (0.79, 0.98)]. LATCH is an innovative intervention designed to enhance the capacity of breastfeeding peer counselors and holds much potential for improving exclusive breastfeeding rates in this population.Support or Funding InformationThis project has been funded with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service through grant WIC NEI‐12‐TX to Baylor College of Medicine to Dr. Rafael Pérez‐Escamilla at Yale University. The contents of this publication do not necessarily reflect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.