Feasibility, acceptability, and preliminary impact of an mHealth supported breastfeeding peer counselor intervention in rural India

Abstract

Objective: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF). Methods:In this quasi-experimental pilot study, participants received either the intervention plus usual care (n = 110) or usual care alone (n = 112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. Progress notes and surveys were used to assess feasibility. Logistic regression models were used for between-group comparisons of optimal infant feeding outcomes, including EBF for 6 months. Results:The intervention was delivered as intended, maintained over the study period, and had high acceptability ratings. There were statistically significant differences in all outcomes between groups. The intervention group had a significantly higher likelihood of EBF at 6 months compared to the control group (adjusted odds ratio 3.57, 95% confidence interval 1.80-7.07). Conclusion:Integration of mHealth with community-based peer counselors to educate women about EBF is feasible and acceptable in rural India and impacts maternal breastfeeding behaviors.

Experiences of peer counsellors in supporting exclusive breastfeeding in southern India: An exploratory qualitative study

“…5 A novel component of the intervention was the incluclusion of a mobile health (m-Health) application, based on a World Health Organization curriculum adapted to the local culture. 6 All 25 women successfully met knowledge and counselling competencies and were each assigned five to seven pregnant women who had consented to receiving breastfeeding counselling. Two counselling sessions were scheduled prior to delivery and seven occurred during post-delivery home visits (within 3 days of delivery, on days 7 and 14, and at 1, 2, 4 and 6 months after delivery).…”

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

“…Brief training with mothers with prior breastfeeding experiences to serve as PCs, using mHealth technology as suitable support tools, within rural Indian communities can further expand the types of available CHWs. They would further address the need for community-based peer support to promote breastfeeding in rural India [26]. Thus, Breastfeeding Education Support Tool for Baby (BEST4Baby) is a suitable medium for training and supporting unpaid PCs in providing in-home breastfeeding counseling support to mothers in rural India.…”

“…The team created the BEST4Baby app to provide a systematic step-by-step guide [26,27] to control the quality of PC counseling at each visit and promote optimal breastfeeding practices in mothers. BEST4Baby's unique features included (1) a step-by-step guide for each visit on proper breastfeeding counseling and education, (2) systematic breastfeeding assessments for mothers during the initial prenatal and postpartum period to shape beliefs and troubleshoot breastfeeding challenges, (3) time-sequenced prenatal and postpartum period education to deliver appropriate just-in-time breastfeeding information, and (4) personalized communication to address specific breastfeeding challenges of lactating mothers during the postpartum period.…”

“…A total of 56 potential PCs were identified by staff from 5 local primary health centers in the Belagavi health district, facilitated through announcements and word of mouth [26]. Out of 56 PCs, 25 (45%) were selected for usability testing of the platform based on the inclusion criteria of (1) residing in the local community; (2) having breastfed within the past 5 years; (3) having at least 10 years of formal education; (4) having an available mobile phone; (5) being familiar with operating an Android phone; and (6) being able to read, write, and communicate in the local language.…”

“…The usability survey was translated into the local language before it was administered. The participants were all female, with a mean age of 30.18 (SD 4.43) years [26]. Half of the participants reported having at least 8 to 10 years of education, with the remainder having 11 to 16 years of education; all had prior experience of using a smartphone for an average of 14.95 months (Table 1).…”