Maternal and co-parental experiences and satisfaction with a co-parenting breastfeeding eHealth intervention in Canada.

BACKGROUND: Suboptimal breastfeeding rates are a public health priority. Interventions that include both breastfeeding women and their co-parents can increase breastfeeding initiation, duration, and exclusivity. eHealth can be an effective means of designing such interventions, as parents increasingly use the internet to access health information. The objective of this study was to determine maternal and co-parent satisfaction with an eHealth intervention. METHODS: The study was part of a larger randomized controlled trial that took place in Canada between March 2018 and April 2020. Data was collected from mothers (n = 56) and co-parents (n = 47). INTERVENTION: The eHealth intervention group received: 1) continued access to an eHealth breastfeeding co-parenting resource from the prenatal period to 52 weeks postpartum; 2) a virtual meeting with a research assistant; and 3) 6 weekly emails reminders. Follow-up data were collected via online questionnaires completed at 2 weeks post enrollment and 4, 12, 26, and 52 weeks postpartum to determine use and satisfaction with the intervention components. FINDINGS: The majority of mothers and co-parents independently reviewed the eHealth resource (95% and 91%, respectively), with higher use in the prenatal period. Participants found the resource to be useful (92%), informative (93%), targeted both parents (90%), and easy to understand (97%). Participants indicated the resource was comprehensive, easily navigated, convenient, and engaging. APPLICATION TO PRACTICE: Providing mothers and their co-parents with breastfeeding co-parenting support via an eHealth intervention delivers accessible, comprehensive information which may assist them in meeting their breastfeeding goals.

Designing an eHealth Breastfeeding Resource With Young Mothers Using a Participatory Design.

INTRODUCTION: Breastfeeding rates among young mothers are low and do not meet recommendations from health authorities, putting the health of young mothers and their infants at risk. Young mothers require breastfeeding support that meets their learning needs and preferred mode for accessing information. The objective of this study was to work collaboratively with young mothers in order to cocreate an eHealth breastfeeding resource. METHODOLOGY: A three-phase exploratory study was conducted in Ontario, Canada. In Phases I and II, young mothers and health care providers (HCPs) were recruited and preferences for an eHealth breastfeeding resource were explored. In Phase III, feedback from young mothers and HCPs about the new resource was collected. RESULTS: Participants found the breastfeeding eHealth resource visually appealing, engaging, and informative. DISCUSSION: Cocreating a tailored breastfeeding eHealth resource with young mothers and HCPs using a participatory approach ensured that the resource design and content met the learning needs of young mothers.

The comparison of access to an eHealth resource to current practice on mother and co-parent teamwork and breastfeeding rates: A randomized controlled trial.

BACKGROUND: Breastfeeding rates are suboptimal, putting mothers and their infants' health at risk. One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals has been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. OBJECTIVES: To compare two study conditions to determine: (1) which way is more effective to provide breastfeeding education to women and their co-parents on increasing breastfeeding rates and associated secondary outcomes, such as breastfeeding knowledge, attitude, self-efficacy and overcoming challenges; (2) the difference in co-parenting and partner support between the study groups; (3) how parents in both groups preferred to access breastfeeding information; and (4) the groups' satisfaction with the eHealth resource that was provided. DESIGN: This study used a randomized controlled trial design (Clinicaltrials.org #NCT03492411). Participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant. Participants in Study Condition #1 (SC1) accessed a previously created, online e-Health resource, in addition to other generally available resources they could access in the community; participants in Study Condition #2 (SC2) accessed only the generally available resources. SETTING: Participants were recruited in health care providers' offices and services for expectant parents in Ontario and via social media throughout Canada. PARTICIPANTS: Expectant women (n = 113) and their co-parents (n = 104) were enrolled. METHODS: After eligibility was determined, consents obtained and baseline surveys completed, group allocation was conducted. SC1 had a virtual meeting with a research assistant to review the eHealth resource. Weekly emails were sent to all participants for 6 weeks as reminders. Follow-up data were electronically collected from mothers and co-parents at 2 weeks post enrollment and 4, 12, 26 and 52-weeks postpartum. RESULTS: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% 'exclusive' 6 months) and (SC1 71% and SC2 78% 'any' 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly. CONCLUSION: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

Development, psychometric assessment, and predictive validity of the comprehensive breastfeeding knowledge scale.

AIM: To develop a breastfeeding knowledge scale that aligns with the Baby Friendly Hospital Initiative and psychometrically test it among expectant parents. BACKGROUND: Although breastfeeding is recommended by all leading health authorities, rates remain suboptimal with women often not achieving their breastfeeding goals. One factor found to positively influence infant feeding behaviours is increased maternal breastfeeding knowledge. However, little research has been conducted validating the dimensions of breastfeeding knowledge to guide interventions to promote positive breastfeeding outcomes. DESIGN: Following an extensive literature review, the 28-item Comprehensive Breastfeeding Knowledge Scale (CBKS) was developed and psychometrically tested. METHOD: A sample of 217 Canadian expectant parents (113 women and 104 coparents) was recruited and administered the CBKS with follow-up questionnaires at 4 and 12 weeks postpartum. Psychometric analyses included exploratory factor analysis, internal consistency, concurrent validity, and predictive validity. RESULTS: Exploratory factor analysis resulted in three dimensions: (1) managing milk supply; (2) persisting through challenges; and (3) correcting misconceptions. Coefficient alpha for the total scale was 0.83 and support for concurrent validity was demonstrated through significant positive correlations with the Iowa Infant Feeding Attitude scale. Further, higher total and subscale scores in pregnancy were associated with exclusive breastfeeding at 4 and 12 weeks postpartum, providing good evidence for predictive validity. CONCLUSION: Preliminary data suggest the CBKS is a valid and reliable measure of breastfeeding knowledge. Upon further testing, this self-report measure may be used to (1) identify women with low breastfeeding knowledge requiring targeted support, (2) individualize health professional care with breastfeeding women, and (3) evaluate the effectiveness of breastfeeding interventions and programs.

Designing an eHealth Breastfeeding Resource With Indigenous Families Using a Participatory Design.

INTRODUCTION: The traditional practice of breastfeeding has been negatively affected by the historical trauma experienced by the Canadian Indigenous community. Culturally relevant information and support should be created to enable the communities to reclaim this traditionally revered infant feeding method. The objective of this participatory design study was to work in partnership with Indigenous communities to create an eHealth breastfeeding resource for Indigenous families. METHODOLOGY: In partnership with Indigenous mothers and care providers in Ontario, Canada, an eHealth breastfeeding resource was designed based on their recommendations. Once the new resource was created, it was evaluated by additional Indigenous mothers. RESULTS: The participants indicated the resource was culturally relevant and that they liked the content and design. DISCUSSION: Using a participatory design when creating services and programs in partnership with Indigenous communities ensures the creation of resources that meet their needs, are culturally relevant, and align with cultural beliefs.

The Development and piloting of an eHealth breastfeeding resource targeting fathers and partners as co-parents.

OBJECTIVE: Traditionally breastfeeding education programs target mothers solely. The objective of this study was to design and pilot test an interactive eHealth breastfeeding co-parenting resource developed to target both mothers and fathers. eHealth resources provide an accessible and engaging format on which to educate parents and assist them in meeting their breastfeeding goals. Best practices to design such resources are not currently known. DESIGN: A three phase pilot study was conducted. The three phases included conducting a needs assessment, creating the resource and pilot testing the resource with mother, father and health care professionals to determine their perspectives regarding the usability and design of the prototype resource. The interactive prototype resource was designed to provide information to parents on breastfeeding and co-parenting, which included suggestions on how fathers can be involved and support breastfeeding and how the couples can work as a team to meet their breastfeeding goals. Setting: Recruitment took place in a health region in Southern Ontario, Canada between June 2014 and March 2015. Online questionnaires were completed by participants in all phases of the study. PARTICIPANTS: Participants (n=149) were pregnant or new mothers and their partners in the health region who read and speak English and had access to the internet and health care professionals who work with breastfeeding families in Ontario, Canada. INTERVENTION: A prototype eHealth breastfeeding co-parenting resource was developed based on maternal and paternal feedback from Phase I and utilized an interactive interface which included games and multimodal information delivery. The prototype eHealth resource was provided to the parents in Phase II and health care professionals in Phase III. The final resource was created based on feedback from these participants. MEASUREMENTS AND FINDINGS: The resource was pilot tested with new and expectant parents using pre- and post-test questionnaires which included measures for breastfeeding self-efficacy (Breastfeeding Self-Efficacy Short Form), infant feeding attitude (Iowa Infant Feeding Attitude Scale), breastfeeding knowledge (Breastfeeding Knowledge Questionnaire) and co-parenting relationship (Co-parenting Relationship Scale). Maternal and paternal breastfeeding self-efficacy and knowledge and infant feeding attitude scores all increased from pre-test to post-test. However, there was no difference in the co-parenting relationship scores from pretest to post-test. KEY CONCLUSIONS: This study has used feedback from parents and health professionals to develop a prototype resource which appears to be effective in increasing parents' breastfeeding knowledge, attitude and self-efficacy. The prototype resource was rated positively by parents and health care providers. IMPLICATIONS FOR PRACTICE: An eHealth breastfeeding co-parenting resource designed with input from the target population is an effective way of providing information to mothers and fathers. Further research with a randomized controlled design and more diverse populations is needed to determine effectiveness of the resource on breastfeeding duration and exclusivity.