#BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding

Abstract

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

Social Media Usage as a Form of Breastfeeding Support Among Black Mothers: A Scoping Review of the Literature

“…For Black women facing social barriers, particularly during times such as the COVID‐19 pandemic, membership in online breastfeeding communities can be a safe alternative to in‐person support groups. Moreover, breastfeeding interventions via social media have shown promise at increasing the rate of research participation among Black women and are an effective method for breastfeeding education distribution 44 . Therefore, incorporating social media in breastfeeding interventions for Black women can improve breastfeeding behaviors by providing information, support, and an increase in self‐efficacy.…”

“…Moreover, breastfeeding interventions via social media have shown promise at increasing the rate of research participation among Black women and are an effective method for breastfeeding education distribution. 44 Therefore, incorporating social media in breastfeeding interventions for Black women can improve breastfeeding behaviors by providing information, support, and an increase in self-efficacy. Future research questions stemming from this study are (1) What forms of breastfeeding social support do Black women seek within social media support groups?…”

Social Networking Services as a Tool for Support of Mothers: A Literature Review

“…In relation to such literacy, as another topic that was frequently described, securing and training human resources are mandatory when mothers use SNSs. Although mothers require correct medical information on pregnancy, childbirth, and childcare, 26 , 29 , 31 , 34 , 36 , 40–43 incorrect information can be spread; thus, the involvement of human resources with professional knowledge in social networking sites that provide support for mothers is expected. 32 In fact, we could observe that the individuals providing support included licensed midwives, 29 trained peer breast-training counselors, 40 and female obstetricians/gynecologists with more than 25 years of practice.…”

The BabyTok Project: Examining the Feasibility and Acceptability of a Light-Touch Social Media Project for Infant–Toddler Teachers

“…Light touch interventions are typically low-cost to the user and are widely accessible to recipients. Examples include the use of video clips sent via text messages to help parents use and respond to gestures with their infants (Choi & Rowe, 2021 ; Rowe et al, 2019 ), to improving nutrition (Chau et al, 2018 ), breastfeeding rates (Dauphin et al, 2020 ), and vaccine usage (O’Leary et al, 2019 ). Social media platforms offer a potential avenue for light-touch interventions, and their potential for PD grew during the COVID-19 pandemic.…”