Background In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. Trial Registration ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235
INTRODUCTION: Breastfeeding reduces the risk of breast cancer. Disparities exist in breastfeeding with about 59% of African-American infants ever being breastfed versus 75% of white infants. One possible explanation is that African-American women may not be discussing benefits of breastfeeding. Thus, this pilot study explores the use of social media to engage pregnant African-American women in education about breastfeeding and to test its impact on breastfeeding outcomes. METHODS: This study was a randomized intervention enrolling eligible African-American women in Buffalo over 18 months into one of two private Facebook groups. The intervention arm received breastfeeding plus breast cancer risk-reduction messaging while the control arm received messaging about breastfeeding alone. A subset of the intervention and control arms failed to join the assigned Facebook group thus creating “true controls” for the study. Participants completed pre- and post-birth assessments. RESULTS: 288 women (N=135 in intervention arm, N=153 in control arm) were randomized into the study. Pre-birth, 76.7% of true controls, 74.7% of breastfeeding-only, and 85.9% of the intervention-group were planning to breastfeed, but, respectively, only 24.6%, 34.6%, and 32.9% exclusively breastfeed post-birth. Breast cancer risk perceptions did not differ between pre-birth and post-birth for the intervention group. The percentage of controls who responded that their risk was “very low” or “somewhat low” significantly increased from 61.5% at pre-birth to 80.0% at post-birth. CONCLUSION: Exclusive breastfeeding is high among groups receiving social media messaging. Therefore, continued and improved efforts should be made to use social media to promote breastfeeding and its benefits.
BACKGROUND In the US, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (ER-) among African American women, with higher risk in those African American women who did not breastfeed their children. OBJECTIVE This paper describes a process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine if social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. METHODS The pilot study was conducted in collaboration with a local Women, Infants and Children (WIC) organization and local healthcare network’s hospital and prenatal clinics. To engage African American women to enroll into the study, several methods and monitoring processes were explored including WIC text-based “e-blast” messages, keyword response to text from flyers and posters in local community based organizations, hospital and prenatal clinics, keyword response using electronic links posted in established Facebook groups and “snowball” recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to two study conditions: an intervention group receiving messages about breast cancer risk reduction and breastfeeding, or a control group receiving breastfeeding only messages. Data were obtained through electronic monitoring, SurveyMonkey®, qualitative responses on Facebook, focus groups and interviews. RESULTS Over 3,000 text messages were sent and received through WIC E-blasts, and keyword responses from flyers. Four hundred seventy-two women were recruited through WIC e-blast and 161 responded to flyers and contacts through local healthcare network, community-based organizations, Facebook and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of n=288 African American pregnant women were enrolled, consented and completed pre-survey assessments (103% of goal) and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. CONCLUSIONS This process evaluation suggests that using electronic, smartphone applications with social media holds promise for both recruitment and conduct of health education intervention studies for African American pregnant women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. CLINICALTRIAL Trial Registration: ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235
Purpose of Study: Incidence rates for aggressive ER- breast cancer in African Americans have continued to increase, and epidemiologic studies (AMBER Consortium) suggest breastfeeding can reduce risks for this deadly disease. Notably, breastfeeding rates are lowest among poor, younger, and African American mothers, offering an opportunity to intervene. Health behavior theories show that perceived risk for health problems can be a motivating factor for behavior change. The purpose of this NCI R21 study was to examine the behavioral impact of a tailored intervention to disseminate new scientific findings about reducing cancer risk for African American women by breastfeeding. Methods: A multimodal approach was used to reach pregnant African American women accessing services through Women, Infant and Children (WIC), community-based organizations and OB/GYNs to invite them to participate in a tailored social media educational intervention. Recruitment was delivered using Telerivet (computer-based mobile messaging platform) and participants were connected to an automated invitation to Survey Monkey to complete eligibility, consent, and pre and post-partum surveys from smart phones. Eligible participants were randomized into a control Facebook (FB) group receiving only breastfeeding messages or an intervention FB group that received both breastfeeding and breast cancer risk reduction messages. All messaging was tailored for African American mothers. Multiple polls and FB actions were used to increase participant engagement. Results: To date, a total of 612 women were recruited, 356 were eligible, 287 women consented, 261 completed pre-surveys, and 134 have currently completed post-surveys. Participants ranged from 18-54 years of age. Preliminary results show significant differences in breast cancer risk perception with an average presurvey mean of 3.07 to a post-survey mean of 1.31 (p <.001). Perceived behavioral control pre- to post-birth indicates significant increases in breastfeeding self-efficacy in knowledge (p < .001), confidence (p =.03), support (p=.002), skills (p=.01), and ease (p=.01). Qualitative interactions were captured through participation in the FB group and intragroup analysis is ongoing. Conclusions: Results will provide crucial information to determine if risk perceptions can be transformative in creating a shift from formula-as-an-equivalent-feeding-practice to “Breast is Best” among African American women within their social context—basically creating a culture-change model. Process data on intervention methods and the potential role to effectively disseminate this new message to increase breastfeeding will be presented. Citation Format: Cassy Dauphin, Frances G. Saad-Harfouche, Maria Keller, Nikia Clark, Elisa M. Rodriguez, D'zare Triplette, Marc Kiviniemi, Deborah O. Erwin. Using social media to communicate breast cancer risk and promote breastfeeding among pregnant African American women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A017.
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