Impact of a novel smartphone app on low-income, first-time mother’s breastfeeding rates: a randomized controlled trial

Abstract Objective Low-income women are less likely to exclusively breastfeed on postpartum day two compared to high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day two. Smartphone applications (apps) provide on-demand video. We aimed to determine whether a novel app—BreastFeeding Friend (BFF)—increases breastfeeding rates for low-income first-time mothers. Methods This double-blinded randomized trial recruited low-income first-time mothers at 36 weeks gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to BFF or a control app. BFF was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle-school teacher and was refined by end-user focus groups. BFF contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a 5th-grade reading level. The control app contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding on postpartum day two; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups via intention-to-treat; pre-specified secondary analyses did so per-protocol. 170 women (85 per arm) were needed to detect whether BFF increased exclusive breastfeeding at postpartum day two from 34% (known baseline) to 56%. Results 253 women were approached; 170 women enrolled. Most participants were Black, and more than half reported annual household incomes Conclusion Neither app improved breastfeeding rates among low-income first-time mothers above the known baseline rates, despite user perception that BFF was the best breastfeeding resource at six weeks postpartum. By demonstrating the feasibility of app-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes. Clinical Trial Registration: NCT03167073