Effect of a Novel Smartphone Application on Breastfeeding Rates Among Low-Income, First-Time Mothers Intending to Exclusively Breastfeed: Secondary Analysis of a Randomized Controlled Trial.

Objective: To examine the effect of a novel smartphone application (app)-BreastFeeding Friend (BFF)-on breastfeeding rates among low-income first-time mothers planning exclusive breastfeeding. Methods: A recent randomized controlled trial (RCT) randomized low-income first-time mothers to BFF or control app. BFF contained breastfeeding education and videos. The control app contained digital breastfeeding handouts. Outcomes included breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. After enrollment, nearly half the participants reported planning formula feeding after breastfeeding initiation, potentially confounding the RCT results. In this secondary analysis, women planning formula feeding were excluded. Outcomes between study groups were compared by intent-to-treat. Results: Of the original 170 participants, 41 in BFF and 46 in control group planned exclusively breastfeeding and were included. Exclusive breastfeeding rates were similar from 2 days postpartum (BFF: n = 19 [48.7%] versus control app: n = 21 [46.7%]; relative risk [RR] = 1.04, 95% confidence interval, CI = 0.67-1.63]) until 6 months postpartum. At 6 weeks postpartum, the majority of BFF users (n = 23 [62.2%]) believed an app provided the best breastfeeding support compared with 39% of control app users (n = 16; RR = 1.59 [95% CI = 1.01-2.52]). BFF users were 2.5 times more likely to deny having breastfeeding challenges compared with control app users (n = 12 [42.9%] versus n = 6 [16.7%]; RR = 2.57 [95% CI = 1.10-6.00]). Conclusion: BFF reduced self-reported breastfeeding challenges and was perceived as the best breastfeeding resource at home but did not increase breastfeeding rates among low-income first-time mothers desiring to exclusively breastfeed. BFF shows promise but must be further optimized to ultimately impact breastfeeding rates. Trial Identification Number: NCT03167073.