A Community-based Intervention Studyusing Short Message Services And Internet To Promote Breastfeeding

BackgroundBreast milk is the ideal food for neonates and infants. According to Global Strategy for Infant and Young Child Feeding, exclusive breastfeeding is recommended up to6months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. However, china’s breastfeeding situation is not ideal. The2008Fourth National Health Services Survey Report showed, exclusive breastfeeding rate of0～6months was only27.6%, with15.8%in urban areas and30.3%in rural areas. World Health Organization(WHO) pointed out that all mothers could breastfeeding if they have correct information and support from family and health care systems.Study have shown that compared with routine services, breastfeeding intervention can more effectively improve breastfeeding.Recently, due to the characteristics of convenience and anytime, anywhere barrier-free communication, mobile phones and the Internet have gradually become the main form of communication. Meanwhile, they also brought opportunities for various types of health behavior interventions. Study indicated that breastfeeding promotion programs delivered via the Internet might be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support.ObjectiveTo explore the model of intervention using SMS and the Internet to promote breastfeeding, and to evaluate the effects of the interventions, based on existing community maternal and child health service system.MethodsThis study is a community-based quasi-experimental trial. It is a part of Nestle project "A community-based intervention Study using short message services and internet to promote reasonable feeding for preventing childhood obesity"(ID: FN4042). Intervention results to4month postpartum were followed up. The research sites are Longhua, Caohejing community health service centers, Xuhui District, Shanghai and Meilong, Xinzhuang community health service centers. Minhang District, Shanghai. The research participants included641pregnant women who came to the study sites registering and meeting the inclusion criteria during September2010and February2011, with308in intervention group and333in control group.Based on baseline survey and qualitative interviews before the intervention, an expert meeting was held to develop the specific intervention programs and content. The intervention program include:(1)using Fetion/Frontline SMS to send an intervention SMS per week;(2)using SMS/Fetion/QQ for consultation to realize one-to-one timely communication;(3)creating QQ mother group for peer exchange;(4)using QQ space to disseminate knowledge;(5)regularly asking about breastfeeding status, and providing encouragement. Interventions started from28weeks of gestation, and continued to4month postpartum. The control group received routine care in maternal health services.Within1month postpartum, participants were followed up to complete breastfeeding self-efficacy scale, meanwhile the data of birth and postpartum experiences were collected. Breastfeeding status of subjects at one month, two month, and four month were followed up.The effects of interventions on breastfeeding rates within1month postpartum and exclusive/breastfeeding rate at1,2and4months were evaluated. In addition, in order to further understand the intervention effect and participants’suggestions on the program, qualitative interviews of part of intervention group were performed.Result1. Follow-up rate641pregnant women were enrolled in the baseline survey, with308in the intervention group and333in the control group. The follow-up rate of postpartum visit within one month was87.05%. The follow-up rate of1month postpartum was90.64%, with90.02%at2month and4month postpartum. 2. Feasibility and acceptability of using SMS and the Internet to promote breastfeeding96.3%of the pregnant women could go online at home or in the work unit using a computer.83.8%of the pregnant women used Internet chat software,80.4%of the pregnant women were willing to join the Internet interventional project.94.5%of the pregnant women continued to use the telephone.86.0%of the pregnant women were willing to accept SMS intervention.3. Effects of interventions on breastfeeding rates of postpartum visitThe breastfeeding rate of postpartum visit in the intervention group was similar to that of in the control group, with98.5%in the intervention group and98.3%in the control group. The exclusive breastfeeding rate of postpartum visit in the intervention group was higher than that of in the control group, with52.4%in the intervention group and46.7%in the control group. Univariate logistic regression for the exclusive breastfeeding rate showed that the differences were not statistically significant (crude OR:1.255,95%CI:0.898～1.756). Multivariate logistic regression showed that after adjusting for the potential confounding factors, the exclusive breastfeeding rate of postpartum visit in the intervention group was higher than that of in the control group (Adjusted OR:2.27,95%CI:1.439～3.593).4. Effects of intervention on breastfeeding rate of1,2and4monthThe breastfeeding rates of1month were95.8%in the intervention group and96.6%in the control group. The breastfeeding rates of2month were90.3%in the intervention group and93.3%in the control group. The breastfeeding rates of4month were83.2%in the intervention group and80.9%in the control group. Univariate analysis revealed no statistically significant difference between the two groups.Usfing the generalized estimating equation it showed that after adjusting for the time trend, return to work and potential confounding factors, the breastfeeding rate of the intervention group was significantly higher than that of the control group(OR:2.078.95%CI:1.201～3.596). 5. Effects of intervention on exclusive breastfeeding rate of1,2and4monthThe exclusive breastfeeding rates of1month were59.4%in the intervention group and53.0%in the control group. The exclusive breastfeeding rates of2month were58.1%in the intervention group and50.3%in the control group. The exclusive breastfeeding rates of4month were48.0%in the intervention group and41.6%in the control group. Although the rates of the intervention group were higher than that of the control group, univariate analysis revealed no statistically significant difference between the two groups.Using generalized estimating equation it showed that after adjusting for the time trend, return to work and potential confounding factors, the exclusive breastfeeding rate of the intervention group was significantly higher than that of the control group(OR:1.767,95%CI:1.260～2.478).ConclusionUsing SMS and the Internet to promote breastfeeding is feasible and acceptable. And using SMS and the Internet for breastfeeding intervention can effectively improve breastfeeding rate and exclusive breastfeeding rate.