User-centred development of an eHealth intervention to support infant feeding choice and confident and safe breastfeeding or formula feeding

Breastfeeding infants until they are 6 months old reduces the risk of serious illnesses for both infants and mothers. In the UK, most mothers start to breastfeed after they give birth and want to continue. However, many mothers experience difficulties with breastfeeding such as pain or concerns about producing enough milk, and as a result, stop breastfeeding earlier than they intended. This means they miss important health benefits for themselves and their infants. Often, the problems that mothers experience with breastfeeding could be prevented or resolved with advice and support, but health professionals do not have the time or skills to offer this consistently to all mothers. For mothers who choose not to breastfeed, or who stop breastfeeding early, the alternative is to bottle-feed infants with specially prepared 'formula' milk. However, parents report finding it difficult to access information about how to bottle feed safely, which may mean they make errors in sterilisation or preparation of feeds, or encourage babies to 'overfeed'. This further increases the health risk to young infants as a result of bottle feeding.

Many pregnant women, mothers, and service providers seek to find out more information about infant feeding by looking online, but they find it difficult to identify accurate and reliable information sources. There are many reliable sources of reliable infant feeding information online such as NHS Choices, or specific parenting websites, but few have been designed with the user-experience in mind meaning some parents may still find it difficult to find the information they need. This project aims to assess the information needs of parents and healthcare staff and directly involve them in the design of a new web-portal and smartphone application. The aim of these tools is to provide parents with up-to-date, evidence-based information and to increase their confidence in whichever infant feeding method they choose. The web-portal will contain sections to help parents decide how they wish to feed their baby, and to prepare to do so safely whichever method they choose. The smartphone app will aim to support mothers who initiate breastfeeding to overcome common difficulties, and will include video guidance on effective breastfeeding techniques, and sections designed specifically to improve mothers' confidence to continue breastfeeding. The content and features of both the web-portal and app will be clearly specified and designed to be attractive and easy to use.

When built, the complete intervention (web-portal and smartphone app) will be made available for all parents and staff associated with one Children's Centre in a deprived area of Coventry. We will measure the uptake of the web-portal and app by staff and parents, and ask them for feedback about the usefulness of the intervention. This intervention aims to support parents to feel more confident about infant feeding, whichever method they choose. It is hypothesised that improvements in confidence will result in increased rates of breastfeeding and safer bottle feeding which will reduce the incidence of serious infant illness and promote improved parental wellbeing. A future study is planned to test the effectiveness of the intervention for increasing breastfeeding and improving infant health. Should the intervention prove successful, it will be implemented into NHS and public health services in the UK and approaches will be made to international partners to consider adapting the intervention for use in countries such as China where there are similar concerns with infant feeding.

Breastfeeding (BF) for 6 months reduces the risk of serious infant and maternal disease (1,2) but globally less than 40% of babies are fed this way (3). In the UK, there is a steep decline in BF during the first few weeks (4). Many mothers want to breastfeed longer, but stop due to difficulties that could be prevented or resolved with skilled support. NHS services do not have the capacity to offer this level of support reliably. Mothers who stop BF, or choose not to start, also need guidance to reduce the risks associated with bottle feeding and early introduction of solids. Many pregnant women and mothers, and service providers, seek to fill the gap in BF support by looking online for information, but find it difficult to determine what is reliable, usable and evidence based (5). Although there are many mother-focussed sources of online information, few have been systematically developed with the user in mind, or rigorously evaluated for effectiveness (6). This early phase research will (1) Assess the needs of parents and healthcare staff/lay supporters for online infant feeding information and support using literature reviews and focus groups (2) Involve parents and staff in design workshops for the development of a new web portal and smart phone app (3) Specify the behavioural change, information and technological components of the optimum infant feeding eHealth and mHealth intervention (4) Test the prototype intervention for acceptability of the content and the technology platforms with all users when it is implemented into an existing healthcare structure. The outcomes of this research will inform the design and feasibility testing of a future clustered randomised trial of the intervention for clinical and cost effectiveness.