WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial

Li Tang, Andy H Lee, Colin W Binns, Lian Duan, Yi Liu, Chunrong Li, Li Tang, Andy H Lee, Colin W Binns, Lian Duan, Yi Liu, Chunrong Li

Abstract

Background: Exclusive breastfeeding for the first 6 months of life is the optimal way to feed infants. However, recent studies suggest that exclusive breastfeeding rates in China remain low and are well below the recommended target. There has been evidence that a lack of awareness of, or exposure to, breastfeeding information is associated with poor breastfeeding practices. WeChat, the most widely used social networking platform in China, has shown some potential to promote health behaviours. We thus hypothesised that a breastfeeding intervention program delivered via WeChat would achieve at least a 10% increase in exclusive breastfeeding prevalence at 6 months compared to the control group.

Methods: A two-arm, parallel, multicentre randomised controlled trial of 1000 pregnant women will be conducted at four maternity hospitals of Chengdu, China. Eligible women who consent to participate in the trial will be recruited at 28-30 weeks of gestation, and randomly allocated to either the intervention group (participants receive breastfeeding-related information from WeChat) or the control group (participants receive non-breastfeeding information from WeChat) using a central randomisation system on a 1:1 ratio at each participating site. The primary outcomes are exclusive breastfeeding rate and full breastfeeding rate at 6 months postpartum. All randomised participants will be included in the outcome analyses with missing data being imputed based on the best-case and worst-case scenarios. Multilevel mixed regression models will be used in the primary analyses to assess the effectiveness of intervention program on the breastfeeding rates.

Discussion: This trial uses the most widely used social media program as a means of delivering messages to mothers to increase exclusive breastfeeding in China. Increasing exclusive breastfeeding will contribute to meeting the health and environmental goals of the Sustainable Development Guidelines. Trial registration ClinicalTrials.gov, NCT04499404. Registered 5 August 2020-Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04499404.

Keywords: Exclusive breastfeeding; Randomised controlled trial; Smart phone; WeChat.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the RCT
Fig. 2.
Fig. 2.
Examples of pushed content (a example of pushed content for the intervention group; b example of pushed content for the control group). The image depicted in figure is our own.

References

    1. Hansen K. Breastfeeding: a smart investment in people and in economies. Lancet. 2016;387(10017):416. doi: 10.1016/S0140-6736(16)00012-X.
    1. Lee MK, Binns C. Breastfeeding and the Risk of Infant Illness in Asia: A Review. Int J Environ Res Public Health. 2019;17(1):186. doi: 10.3390/ijerph17010186.
    1. World Health Organization, UNICEF. Global strategy for infant and young child feeding. WHO, Geneva; 2003. . Accessed 10 May 2020.
    1. Lamberti LM, Fischer Walker CL, Noiman A, Victora C, Black RE. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health. 2011;11(Suppl 3):S15. doi: 10.1186/1471-2458-11-S3-S15.
    1. Khan MN, Islam MM. Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study. BMC Public Health. 2017;17(1):889. doi: 10.1186/s12889-017-4913-4.
    1. Lamberti LM, Zakarija-Grkovic I, Fischer Walker CL, Theodoratou E, Nair H, Campbell H, et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Public Health. 2013;13(Suppl 3):S18. doi: 10.1186/1471-2458-13-S3-S18.
    1. Victora CG, Horta BL, Loret de Mola C, Quevedo L, Pinheiro RT, Gigante DP, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health. 2015;3(4):e199–205. doi: 10.1016/S2214-109X(15)70002-1.
    1. Tang L, Binns CW, Luo C, Zhong Z, Lee AH. Determinants of breastfeeding at discharge in rural China. Asia Pac J Clin Nutr. 2013;22(3):443–448.
    1. Liu P, Qiao L, Xu F, Zhang M, Wang Y, Binns CW. Factors associated with breastfeeding duration: a 30-month cohort study in northwest China. J Hum Lact. 2013;29(2):253–259. doi: 10.1177/0890334413477240.
    1. Tang L, Binns CW, Lee AH. Infant formula crisis in china: a cohort study in sichuan province. J Health Popul Nutr. 2015;33(1):117–122. doi: 10.1186/s41043-015-0019-8.
    1. Qiu L, Binns CW, Zhao Y, Lee AH, Xie X. Breastfeeding practice in Zhejiang province, PR China, in the context of melamine-contaminated formula milk. J Health Popul Nutr. 2010;28(2):189–198.
    1. UNICEF. Breastfeeding in China: improving practices to improve China’s future. UNICEF; 2017.
    1. China Development Research Foundation. Report on factors associated with breastfeeding in China (conference version). Beijing; 2019.
    1. Ouyang YQ, Su M, Redding SR. A survey on difficulties and desires of breast-feeding women in Wuhan, China. Midwifery. 2016;37:19–24. doi: 10.1016/j.midw.2016.03.014.
    1. Jiang H, Li M, Yang D, Wen LM, Hunter C, He G, et al. Awareness, intention, and needs regarding breastfeeding: findings from first-time mothers in Shanghai. China Breastfeed Med. 2012;7(6):526–534. doi: 10.1089/bfm.2011.0124.
    1. UNICEF. The global breastfeeding collective 2019. . Accessed 17 May 2020.
    1. Jiang H, Li M, Wen LM, Hu Q, Yang D, He G, et al. Effect of short message service on infant feeding practice: findings from a community-based study in Shanghai, China. JAMA Pediatr. 2014;168(5):471–478. doi: 10.1001/jamapediatrics.2014.58.
    1. Lee SH, Nurmatov UB, Nwaru BI, Mukherjee M, Grant L, Pagliari C. Effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries: systematic review and meta-analysis. J Glob Health. 2016;6(1):010401. doi: 10.7189/jogh.06.010401.
    1. Hudnut-Beumler J, Po'e E, Barkin S. The use of social media for health promotion in Hispanic populations: a scoping systematic review. JMIR Public Health Surveill. 2016;2(2):e32. doi: 10.2196/publichealth.5579.
    1. Dumas AA, Lapointe A, Desroches S. Users, uses, and effects of social media in dietetic practice: scoping review of the quantitative and qualitative evidence. J Med Int Res. 2018;20(2):e55.
    1. Zhang X, Wen D, Liang J, Lei J. How the public uses social media wechat to obtain health information in china: a survey study. BMC Med Inform Decis Mak. 2017;17(Suppl 2):66. doi: 10.1186/s12911-017-0470-0.
    1. Zhang T, Xu L, Tang Y, Cui H, Li H, Wei Y, et al. Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis. Aust N Z J Psychiatry. 2018;52(4):375–382. doi: 10.1177/0004867417712460.
    1. He C, Wu S, Zhao Y, Li Z, Zhang Y, Le J, et al. Social media-promoted weight loss among an occupational population: cohort study using a WeChat mobile phone app-based campaign. J Med Int Res. 2017;19(10):e357.
    1. Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e17–e18. doi: 10.1016/S2215-0366(20)30077-8.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586.
    1. Chen S, Binns CW, Liu Y, Maycock B, Zhao Y, Tang L. Attitudes towards breastfeeding—the Iowa Infant Feeding Attitude Scale in Chinese mothers living in China and Australia. Asia Pac J Clin Nutr. 2013;22(2):266–269.
    1. Tang L, Binns CW, Lee AH, Pan X, Chen S, Yu C. Low prevalence of breastfeeding initiation within the first hour of life in a rural area of Sichuan Province. China Birth. 2013;40(2):134–142. doi: 10.1111/birt.12038.
    1. Tang L, Lee AH, Binns CW. Factors associated with breastfeeding duration: a prospective cohort study in Sichuan Province. China World J Pediatr. 2015;11(3):232–238. doi: 10.1007/s12519-014-0520-y.
    1. World Health Organization. Indicators for assessing infant and young child feeding practices–part I: definition. WHO, Geneva; 2008. . Accessed 2 Jun 2020.
    1. National Health and Medical Research Council . Literature review: infant feeding guildelines. Canberra: National Health and Medical Research Council; 2012.
    1. Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2008;46(1):99–110. doi: 10.1097/.
    1. Whitley E, Ball J. Statistics review 4: sample size calculations. Crit Care. 2002;6(4):335–341. doi: 10.1186/cc1521.
    1. Tang L, Pan XF, Lee AH, Binns CW, Yang CX, Sun X. Maternal lifestyle and nutritional status in relation to pregnancy and infant health outcomes in Western China: protocol for a prospective cohort study. BMJ Open. 2017;7(6):e014874. doi: 10.1136/bmjopen-2016-014874.
    1. xinhuanet. WeChat annual data report in 2018: 1.01 billion users login WeChat every day 2019 29 September 2019. . Accessed 3 Jun 2020 (in Chinese).
    1. Zhang K, Tang L, Wang H, Qiu L, Binns CW, Lee AH. Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff. Int J Environ Res Public Health. 2015;12(5):4520–4532. doi: 10.3390/ijerph120504520.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel