A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study

Chih-Jau Wang, Pimwadee Chaovalit, Suporn Pongnumkul, Chih-Jau Wang, Pimwadee Chaovalit, Suporn Pongnumkul

Abstract

Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records.

Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women.

Methods: Our study was reviewed and approved by Thailand's National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis.

Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement.

Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system.

Keywords: breast feeding; health promotion; mobile applications; mobile health; usability; usefulness.

Conflict of interest statement

Conflicts of Interest: PC is the principal investigator of MoomMae project.

©Chih-Jau Wang, Pimwadee Chaovalit, Suporn Pongnumkul. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 26.01.2018.

Figures

Figure 1
Figure 1
Evaluation flowchart.
Figure 2
Figure 2
Screenshots of the “feeding record” function. (1) The main screen of the “feeding record” function; (2) Entering a new feeding log; (3) Summary of feeding record; (4) Feeding history. These screenshots are translated into English.
Figure 3
Figure 3
Screenshots of the breast pump function. (1) The breast pump function; (2) Making a new pumping record.
Figure 4
Figure 4
Screenshots of the breastfeeding rooms function. (1) The breastfeeding rooms function. (2) The detail page of a breastfeeding room.

References

    1. Cushing AH, Samet JM, Lambert WE, Skipper BJ, Hunt WC, Young SA, McLaren LC. Breastfeeding reduces risk of respiratory illness in infants. Am J Epidemiol. 1998 May 1;147(9):863–870. doi: 10.1093/oxfordjournals.aje.a009540.
    1. Barness LA, Mauer AM, Holliday MA, Anderson AS, Dallman PR, Forbes GB, Goldbloom RB, Haworth JC, Jesse MJ, Scriver CR, Winick M, Kline OL, Miller RW, O'Brien D. Commentary on breast-feeding and infant formulas, including proposed standards for formulas. Pediatrics. 1976 Feb;57(2):278–85.
    1. Lawrence RA. Breastfeeding: benefits, risks and alternatives. Curr Opin Obstet Gynecol. 2000 Dec;12(6):519–24.
    1. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol. 2004;554:63–77.
    1. UNICEF. New York: United Nations Children's Fund (UNICEF); 2016. The State of the World's Children 2016: A Fair Chance for Every Child .
    1. Thomson G, Ebisch-Burton K, Flacking R. Shame if you do--shame if you don't: women's experiences of infant feeding. Matern Child Nutr. 2015 Jan;11(1):33–46. doi: 10.1111/mcn.12148.
    1. Stuebe A, Bonuck K. What predicts intent to breastfeed exclusively? Breastfeeding knowledge, attitudes, and beliefs in a diverse urban population. Breastfeed Med. 2011 Dec;6(6):413–20. doi: 10.1089/bfm.2010.0088.
    1. Grant A. “I…don’t want to see you flashing your bits around”: Exhibitionism, othering and good motherhood in perceptions of public breastfeeding. Geoforum. 2016 May;71:52–61. doi: 10.1016/j.geoforum.2016.03.004.
    1. Vaughn LM, Ireton C, Geraghty SR, Diers T, Niño V, Falciglia GA, Valenzuela J, Mosbaugh C. Sociocultural influences on the determinants of breast-feeding by Latina mothers in the Cincinnati area. Fam Community Health. 2010;33(4):318–28. doi: 10.1097/FCH.0b013e3181f3b2be.
    1. World Health Organization. Geneva: World Health Organization; 1998. Evidence for the Ten Steps to Successful Breastfeeding .
    1. Berridge K, McFadden K, Abayomi J, Topping J. Views of breastfeeding difficulties among drop-in-clinic attendees. Matern Child Nutr. 2005 Oct;1(4):250–62. doi: 10.1111/j.1740-8709.2005.00014.x.
    1. Wood NK, Sanders EA, Lewis FM, Woods NF, Blackburn ST. Pilot test of a home-based program to prevent perceived insufficient milk. Women Birth. 2017 Dec;30(6):472–80. doi: 10.1016/j.wombi.2017.04.006.
    1. Pate B. A systematic review of the effectiveness of breastfeeding intervention delivery methods. J Obstet Gynecol Neonatal Nurs. 2009;38(6):642–53. doi: 10.1111/j.1552-6909.2009.01068.x.
    1. Bonuck K, Stuebe A, Barnett J, Labbok MH, Fletcher J, Bernstein PS. Effect of primary care intervention on breastfeeding duration and intensity. Am J Public Health. 2014 Feb;104 Suppl 1:S119–27. doi: 10.2105/AJPH.2013.301360.
    1. Jiang H, Li M, Wen L, Hu Q, Yang D, He G, Baur LA, Dibley MJ, Qian X. Effect of short message service on infant feeding practice: findings from a community-based study in Shanghai, China. JAMA Pediatr. 2014 May;168(5):471–8. doi: 10.1001/jamapediatrics.2014.58.
    1. Labarère J, Gelbert-Baudino N, Laborde L, Arragain D, Schelstraete C, François P. CD-ROM-based program for breastfeeding mothers. Matern Child Nutr. 2011 Jul;7(3):263–72. doi: 10.1111/j.1740-8709.2009.00235.x.
    1. Fahami F, Mohamadirizi S, Bahadoranffect P. Effect of electronic education on the awareness of women about post partum breast feeding. Int J Pediatr. 2014;2:57–63. doi: 10.22038/ijp.2014.2985.
    1. Joshi A, Wilhelm S, Aguirre T, Trout K, Amadi C. An interactive, bilingual touch screen program to promote breastfeeding among Hispanic rural women: usability study. JMIR Res Protoc. 2013 Nov 7;2(2):e47. doi: 10.2196/resprot.2872.
    1. Edwards RA, Bickmore T, Jenkins L, Foley M, Manjourides J. Use of an interactive computer agent to support breastfeeding. Matern Child Health J. 2013 Dec;17(10):1961–8. doi: 10.1007/s10995-013-1222-0.
    1. Salonen AH, Kaunonen M, Astedt-Kurki P, Järvenpää AL, Tarkka MT. Development of an internet-based intervention for parents of infants. J Adv Nurs. 2008;64(1):60–72. doi: 10.1111/j.1365-2648.2008.04759.x.
    1. Huang MZ, Kuo SC, Avery MD, Chen W, Lin KC, Gau ML. Evaluating effects of a prenatal web-based breastfeeding education programme in Taiwan. J Clin Nurs. 2007 Aug;16(8):1571–9. doi: 10.1111/j.1365-2702.2006.01843.x.
    1. Clark A, Anderson J, Adams E, Baker S, Barrett K. Assessing an infant feeding web site as a nutrition education tool for child care providers. J Nutr Educ Behav. 2009;41(1):41–6. doi: 10.1016/j.jneb.2007.12.007.
    1. Hannula LS, Kaunonen ME, Puukka PJ. A study to promote breast feeding in the Helsinki Metropolitan area in Finland. Midwifery. 2014 Jun;30(6):696–704. doi: 10.1016/j.midw.2013.10.005.
    1. Scott BL. . The Effectiveness of Internet and Instant Messaging Approaches in Promoting Intention to Breastfeed
    1. García-Gómez JM, de la Torre-Díez I, Vicente J, Robles M, López-Coronado M, Rodrigues JJ. Analysis of mobile health applications for a broad spectrum of consumers: a user experience approach. Health Informatics J. 2014 Mar;20(1):74–84. doi: 10.1177/1460458213479598.
    1. Play.google. [2017-06-18]. Moms Pump Here .
    1. Play.google. [2017-06-18]. latchME - breastfeed easier .
    1. itunes.apple. [2017-06-18]. Mamava pump & nursing finder .
    1. Play.google. [2017-07-09]. Feed Finder .
    1. Play.google. BabyPlaces .
    1. Play.google. [2017-06-20]. Mamamap .
    1. Play.google. [2017-06-18]. Nursing Room SG .
    1. Breastfeedingthai. [2017-06-18]. These places provide “breast milk corner” to facilitate all your mother .
    1. Pandatraveldiary. 2015. Apr 23, [2017-06-17]. Little Panda's Travel Diary
    1. Khajochi. [2017-07-09]. Introducing “Milk Room” at Central World, big and clean .
    1. Play.google. [2017-07-09]. Breastfeeding tracker, pump log and baby diary .
    1. Play.google. [2017-07-09]. Baby Manager - Breastfeeding Tracker & Community .
    1. Play.google. [2017-07-09]. Breastfeeding Tracker Baby Log .
    1. Play.google. [2017-07-09]. Feed Baby - Baby Tracker .
    1. Play.google. [2017-07-09]. Mamma Baby - Breastfeeding Log .
    1. Play.google. [2017-06-17]. Glow Baby Breastfeeding Tracker, Nursing Timer App .
    1. Fanning J, Mullen SP, McAuley E. Increasing physical activity with mobile devices: a meta-analysis. J Med Internet Res. 2012 Nov 21;14(6):e161. doi: 10.2196/jmir.2171.
    1. McKay FH, Cheng C, Wright A, Shill J, Stephens H, Uccellini M. Evaluating mobile phone applications for health behaviour change: a systematic review. J Telemed Telecare. 2018 Jan;24(1):22–30. doi: 10.1177/1357633X16673538.
    1. Mirkovic J, Kaufman DR, Ruland CM. Supporting cancer patients in illness management: usability evaluation of a mobile app. JMIR Mhealth Uhealth. 2014 Aug 13;2(3):e33. doi: 10.2196/mhealth.3359.
    1. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362. doi: 10.1371/journal.pmed.1001362.
    1. Sama PR, Eapen ZJ, Weinfurt KP, Shah BR, Schulman KA. An evaluation of mobile health application tools. JMIR Mhealth Uhealth. 2014 May 1;2(2):e19. doi: 10.2196/mhealth.3088.
    1. Daniels J, Fels S, Kushniruk A, Lim J, Ansermino JM. A framework for evaluating usability of clinical monitoring technology. J Clin Monit Comput. 2007 Oct;21(5):323–30. doi: 10.1007/s10877-007-9091-y.
    1. Nielsen J, Molich R. Heuristic Evaluation of User Interfaces. CHI '90 Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; April 1-5, 1990; Seattle, Washington, USA. New York, NY, USA: ACM; 1990. pp. 249–56.
    1. Bertini E, Gabrielli S, Kimani S, Catarci T, Santucci G. Appropriating and assessing heuristics for mobile computing. AVI '06 Proceedings of the working conference on Advanced visual interface; May 23-26, 2006; Venezia, Italy. New York, NY, USA: ACM Press; 2006. pp. 119–26.
    1. Watkins I, Kules B, Yuan X, Xie B. Heuristic evaluation of healthy eating apps for older adults. J Consum Health Internet. 2014;18(2):105–27. doi: 10.1080/15398285.2014.902267.
    1. Yuan MJ, Finley GM, Long J, Mills C, Johnson RK. Evaluation of user interface and workflow design of a bedside nursing clinical decision support system. Interact J Med Res. 2013 Jan 31;2(1):e4. doi: 10.2196/ijmr.2402.
    1. Faulkner L. Beyond the five-user assumption: benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput. 2003 Aug;35(3):379–83. doi: 10.3758/BF03195514.
    1. BinDhim NF, McGeechan K, Trevena L. Who uses smoking cessation apps? A feasibility study across three countries via smartphones. JMIR Mhealth Uhealth. 2014 Feb 6;2(1):e4. doi: 10.2196/mhealth.2841.
    1. Mann D, Riddell L, Lim K, Byrne LK, Nowson C, Rigo M, Szymlek-Gay EA, Booth AO. Mobile phone app aimed at improving iron intake and bioavailability in premenopausal women: a qualitative evaluation. JMIR Mhealth Uhealth. 2015 Sep 28;3(3):e92. doi: 10.2196/mhealth.4300.
    1. Fanning J, Mackenzie M, Roberts S, Crato I, Ehlers D, McAuley E. Physical activity, mind wandering, affect, and sleep: an ecological momentary assessment. JMIR Mhealth Uhealth. 2016 Aug 31;4(3):e104. doi: 10.2196/mhealth.5855.
    1. Knight BA, McIntyre HD, Hickman IJ, Noud M. Qualitative assessment of user experiences of a novel smart phone application designed to support flexible intensive insulin therapy in type 1 diabetes. BMC Med Inform Decis Mak. 2016 Dec 15;16:119. doi: 10.1186/s12911-016-0356-6.
    1. Kushniruk AW, Patel VL, Cimino JJ. Usability testing in medical informatics: cognitive approaches to evaluation of information systems and user interfaces. Proc AMIA Annu Fall Symp. 1997:218–22.
    1. World Health Organization and Joint United Nations Programme on HIV/AIDS Protecting, promoting and supporting breastfeeding: the special role of maternity services. Int J Gynaecol Obstet. 1990;31 Suppl 1:171–83. doi: 10.1016/0020-7292(90)90104-S.
    1. . 2017. [2017-11-07]. Number and fertility rates Per 1,000 female births by age group, 2002-2016 .

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir