Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study

Abstract

Background Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby’s design and development, including the app’s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby’s usability from the PCs’ perspective was assessed using the translated System Usability Scale (SUS). Results The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group’s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725

A training curriculum for an mHealth supported peer counseling program to promote exclusive breastfeeding in rural India

“…The BEST4Baby app was designed to reinforce training by allowing PCs to use the device during and after the training sessions and in the field. A complete description of app content with screenshots is described in the work by Ma and colleagues [ 29 ]. The app's design included a step-by-step guide for each visit to cover relevant topics for that visit.…”

Effect of Mobile-Based Counselling on Breastfeeding in Spain: A Randomized Controlled Trial Protocol (COMLACT Study)

“…On the other hand, healthcare systems increasingly make use of online services in support of users and healthcare professionals, including the utilization of mobile applications [21]. Nevertheless, it must be taken into account that the use of such tools is not proportional within the population, and that we must ensure that the information provided is not only based on the best available scientific evidence, but is also accessible to women at risk of social exclusion [22]. In line with different studies, the application of a protocolized intervention that is accessible and adapted to the needs of women effectively improves the rates and duration of BF [4,13,14,[23][24][25][26].…”