Breastfeeding challenges, such as pain and perception of insufficient milk
supply, prevent many women from exclusively breastfeeding their babies for
the six-month duration recommended by the World Health Organization.
Mobile health strategies may help women identify and overcome
breastfeeding challenges. This study evaluated a two-way short message
service (SMS) intervention that delivered breastfeeding messages to women
in Kiambu County, Kenya, and its impact on rates of exclusive
breastfeeding and breastfeeding behavior at 1, 4, and 6 months
post-delivery. Women in the control group received a general package of
messages containing postnatal information; women in the intervention group
received these messages, plus messages related to breastfeeding and
surveys which offered more information about breastfeeding challenges.
Both groups of women had access to a help desk agent who responded to
questions via SMS. There was no significant difference in the rate of
exclusive breastfeeding between the intervention and control at any time
point (p=.861). Women in the intervention group were more likely to report
experiencing breastfeeding challenges such as pain and perceived
insufficient milk supply than those in the control group (32% vs. 24%,
p=0.00). Of the women in the intervention group who reported experiencing
breastfeeding challenges, 70% of them found a resolution to their
challenge, and 23% of them resolved their challenges using SMS. SMS may
help women in low-resource settings to identify and overcome their
breastfeeding challenges. Study follow-up took place over a five month period. An external
firm was contracted to collect data via phone surveys conducted by trained
female enumerators. Participants were allocated into mutually exclusive
follow-up groups to be called at either one, four, or six months after
receiving the first postpartum text message, respectively. The
questionnaire was designed and initially pretested with a few PROMPTS
users, and the final tool was piloted with 10 participants before data
collection began. Organizational Network Analysis (ONA) Surveys was used
to host the survey and enumerators captured data using the Open Data Kit
application on their smartphones (getodk.org, 2020; ONA Systems Inc.,
2010). The survey took approximately 15-20 minutes, beginning with
obtaining informed consent. It included questions on breastfeeding and
infant feeding practices, challenges such as pain while breastfeeding and
perceived low milk supply, and demographic questions. The enumerators made
up to three over multiple days attempts to reach the participants and
participants were considered eligible for follow-up within a window of 14
days of their designated follow-up date. The enumerators were blinded to
whether the participants were in the intervention or control groups
throughout the data collection process. Study participants could not be
blinded to their treatment status because the messages they received
either featured breastfeeding information or not. Survey questions were
translated into Swahili and participants were asked to select their
language of choice during the interview. The data are in a .txt file. There is a data dictionary in an
.xlsx file. The questionnaire that was used for data collection is also
included as a .doc file.