Patchen Loral, Tsuei Jeannette, Sherard Donna, Moriarty Patricia, Mungai-Barris Zoe, Ma Tony, Bajracharya Elina, Chang Katie, Evans William Douglas
Healthcare Delivery Research, MedStar Health Research Institute, Columbia, MD, United States.
RAND, Santa Monica, CA, United States.
JMIR Form Res. 2025 Mar 19;9:e67284. doi: 10.2196/67284.
Breastfeeding rates among US mothers, particularly Black or African American mothers, fall short of recommended guidelines. Despite the benefits of human milk, only 24.9% of all infants receive human milk exclusively at 6 months.
Our team previously explored the key content areas a mobile health intervention should address and the usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app guided by preferences of Black or African American parents. This study aimed to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Key social branding elements were defined to guide app development as a trusted adviser. The study also aimed to validate previous findings regarding approaches to supporting breastfeeding goals and cultural tailoring.
We conducted a qualitative study using in-depth interviews and focus groups with potential KULEA-NET users. A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. The Data methods aligned with qualitative research principles and concluded once saturation was reached. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, 1 with expertise in social branding and 1 certified in lactation, participated in the thematic analysis.
All participants identified as Black or African American mothers, and most interview participants (7/12, 58%) engaged in exclusive breastfeeding. In total, 4 themes were recognized. First, participants identified desired content, specifying peer support, facilitated access to experts, geolocation to identify resources, and tracking functions. Second, delivery of content differentiated platforms and messaging modality. Third, functionality and features were identified as key factors, highlighting content diversity, ease of use, credibility, and interactivity. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in web-based forums and internet-based or in-person support groups to help balance the ideal medical recommendations for infant feeding with the contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility.
This formative research suggested additional elements for an expanded KULEA-NET app that would be beneficial and desired. The health branding approach to establish KULEA-NET as a trusted adviser is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial.
美国母亲的母乳喂养率，尤其是黑人或非裔美国母亲的母乳喂养率，未达到推荐标准。尽管母乳有诸多益处，但在6个月大的婴儿中，只有24.9%的婴儿完全以母乳为食。
我们的团队之前探讨了移动健康干预应涉及的关键内容领域，以及基于证据的移动母乳喂养应用程序“利用支持网络的教育与建议进行泌乳知识与应用”（KULEA-NET）初始原型的可用性，该应用程序以黑人或非裔美国父母的偏好为指导。本研究旨在确定扩展版KULEA-NET应用程序的其他功能、内容和交付方式的偏好及可接受性。定义了关键的社会品牌元素，以指导应用程序作为可信赖顾问的开发。该研究还旨在验证先前关于支持母乳喂养目标和文化定制方法的研究结果。
我们采用深入访谈和焦点小组的方式，对KULEA-NET的潜在用户进行了定性研究。健康品牌塑造方法提供了理论框架。我们招募了24名参与者，进行了12次访谈和2次焦点小组讨论，每个小组有6名参与者。数据收集方法符合定性研究原则，达到饱和后结束。鉴于关注文化定制，与研究参与者具有相同社会身份的团队成员完成了数据收集和编码。另外两名团队成员，一名具有社会品牌塑造专业知识，一名具有泌乳认证，参与了主题分析。
所有参与者均为黑人或非裔美国母亲，大多数访谈参与者（7/12，58%）进行纯母乳喂养。总共识别出4个主题。首先，参与者确定了所需内容，具体包括同伴支持、方便接触专家、通过地理位置识别资源以及跟踪功能。其次，内容的交付方式区分了平台和信息传递方式。第三，功能和特性被确定为关键因素，突出了内容多样性、易用性、可信度和交互性。最后，塑造社会品牌的信息的吸引人之处强调了支持与肯定、包容性与身体积极性、母亲的激励、母亲身份、社会规范以及与理想母亲行为保持一致的障碍等基本品质。主题的交叉元素包括希望在网络论坛以及基于互联网或面对面的支持小组中与其他母亲交流，以帮助平衡关于婴儿喂养的理想医学建议与母亲的实际情况和动机。参与者高度重视个性化，并强调需要实现社会可信度和事实可信度。
这项形成性研究为扩展版KULEA-NET应用程序提出了其他有益且受欢迎的元素。将KULEA-NET打造为可信赖顾问的健康品牌塑造方法对用户具有吸引力且可接受。下一步包括开发反映这些研究结果的完整应用程序功能，然后在随机对照试验中测试更新后的KULEA-NET版本。
