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

Abstract

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