Failure to initiate breastfeeding (BF) and exclusively breastfeed (EBF) for the recommended 6-month duration, can result in long-term morbidity among both mothers and their infants. African Americans/Blacks (AA/B) have the lowest BF initiation and EBF rates among all racial ethnicities in the US. AA/B infants have disproportionately high rates of mortality, and children have a high incidence of asthma and sudden infant death syndrome (SIDS) while AA/B mothers are at high risk for chronic illnesses like obesity, diabetes, and cardiovascular diseases. These health disparities cost the US more than $9.1 billion in medical treatment annually but can be reduced by increasing EBF rates. However, AA/B women experience barriers on multiple levels to initiating, continuing BF, and maintaining EBF (either by discontinuing BF or introducing supplements BF with other foods). With high rates of smartphone ownership and consumption of digital content in AA/B women, the proposed mHealth intervention has great potential to increase BF initiation and maintain EBF among AA/B women and has demonstrated feasibility (user satisfaction and use) in our prior completed feasibility study. The proposed SBIR Direct Phase II application, Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET) addresses an unmet need for an evidence-based mobile app, providing comprehensive BF support and addresses the interrelated and complex BF barriers AA/B mothers experience across the socio-ecological layers. KULEA-NET will provide comprehensive BF support to nurture and support AA/B women in BF initiation and EBF, and include the following innovative features: a) Social marketing and health branding to promote EBF as a socially desirable behavior; b) Micro-learning educational content to improve the acquisition of knowledge and skills related to EBF; c) Support network communication tools leveraging asynchronous communication that allow mothers to communicate with her BF supporters, peers, and lactation professional supports; d) Context-aware delivery framework that will capitalize on user information such as date of delivery, feeding and diaper log data, and location variables to provide timely feedback, content, and guidance; and e) a Virtual community support network bringing together AA/B mothers and their spouse/family members, and fostering a community of mutual support. We hypothesize that KULEA-NET will improve knowledge, BF self-efficacy, and intentions to BF, and ultimately achieve increased BF initiation, BF duration, and EBF rates at 6 months among AA/B mothers and, as a result, improved maternal and infant health outcomes.
Public Health Relevance Statement: PROJECT NARRATIVE The SBIR Direct Phase II project completes the development of KULEA-NET, a mHealth intervention that will improve knowledge, self-efficacy, and intentions related to exclusive breastfeeding (EBF). These factors have been demonstrated to have a positive influence on breastfeeding (BF) initiation and duration among African American/Black (AA/B) mothers. In the long term, KULEA-NET has great potential to achieve increased BF initiation and EBF rates among AA/B mothers and as a result, improved maternal and infant health outcomes.
Project Terms: Mother's Milk; maternal milk; Morbidity - disease rate; Morbidity; mortality; Mothers; nutrition; Obesity; adiposity; corpulence; Ownership; Pilot Projects; pilot study; Race; Races; racial; racial background; racial origin; Recommendation; Research; Social Desirability; Social Desirabilities; Social Marketing; Sudden infant death syndrome; Cot Death; Crib Death; SIDS; Sudden Infant Death; Sudden Unexpected Infant Death; Target Populations; Technology; Testing; Time; Universities; Washington; Woman; Work; Afro American; Afroamerican; African American; Family member; Married Persons; Spouses; Job Location; Job Place; Job Setting; Job Site; Work Location; Work Place; Work-Site; Worksite; work setting; Workplace; role model; improved; Site; Phase; Medical; Infant Health; Grips; grasp; Failure; Individual; social norm; Exclusive Breast Feeding; exclusively breast fed; exclusively breast feeding; exclusively breastfed; exclusively breastfeeding; Exclusive Breastfeeding; Fostering; satisfaction; Ethnicity; Ethnic Origin; randomized control trial; Randomized, Controlled Trials; Knowledge; Life; Complex; System; Location; behavior change; interest; experience; Self Efficacy; skills; Participant; peer; social; Intervention; Intervention Strategies; interventional strategy; Cell Phone; Cellular Telephone; Mobile Phones; iPhone; smart phone; smartphone; Cellular Phone; disparity in health; health disparity; Address; Data; Communication Tools; Small Business Innovation Research Grant; SBIR; Small Business Innovation Research; Principal Investigator; Development; developmental; cost; feeding; digital; determine efficacy; efficacy analysis; efficacy assessment; efficacy determination; efficacy examination; evaluate efficacy; examine efficacy; efficacy evaluation; Outcome; Consumption; innovate; innovative; innovation; usability; prototype; high risk; evidence base; m-Health; mobile health; mHealth; mobile app; mobile device application; mobile application; on-line community; virtual community; online community; support network; family support; breast pump; short message service; texting; Text Messaging; Precede-Proceed Model; black women; black female; pilot test; asynchronous communication; asynchronous messaging; Black Populations; Black group; Black individual; Black people; Blacks; African American population; African American group; African American individual; African American people; African Americans; poor health outcome; reduced health outcome; worse health outcome; Adoption; Asthma; Bronchial Asthma; Awareness; Behavior; Black race; Black; Breast Feeding; Breast fed; Breastfed; Breastfeeding; Cardiovascular Diseases; cardiovascular disorder; Child; 0-11 years old; Child Youth; Children (0-21); kids; youngster; Chronic Disease; Chronic Illness; chronic disorder; Communication; Communities; Diabetes Mellitus; diabetes; Knowledge acquisition; Education; Educational aspects; Feasibility Studies; Feedback; Food; Health; Hospitals; Incidence; Infant; Lactation; lactating; lactational; Learning; Maternal Health; Human Milk; Breast Milk; Breastmilk; Human Mother's Milk; Mammary Gland Milk
