Optimising the effectiveness of a digital health intervention to improve breastfeeding rates in children

Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is a digital health model of care delivered via mHealth (text message) that provides families access to evidence-based age and stage related preventive health care, targeting child health and development, breastfeeding, child nutrition, movement behaviours and family/carer wellbeing, from birth to 5 years based on anticipatory guidance. Messages also include immunisation and personal health and development check reminders. Families eligible for HB4HNEKids receive short text messages (160 characters) with clickable links to evidence based ‘online’ videos, fact sheets, websites and relevant support services on average once/week in the first 3 years, and once/fortnight up until the age of 5 years. The delivery of text messages are monitored via SMS reports (i.e. the number of messages successfully delivered), and engagement with text message content is monitored via a URL tracking platform. The existing messages including the breastfeeding module has been piloted via a non-randomised post design and demonstrated a 5% (non-significant) difference in the proportion of mothers breastfeeding at 6 months. This research, via a 2x2 factorial randomised trial will aim to optimise the HB4HNEKids program breastfeeding module and assess the effectiveness of the optimised mHealth intervention on improved infant feeding outcomes at 4 and 6 months. The experimental conditions that will be evaluated include: • Experimental condition 1: messages will be sent to secondary carers/support persons that aim to support the breastfeeding parent. Upon enrolment to HB4HNEKids, a support person will begin to receive text messages for the first 6 months of a child’s life that aim to provide information to support the breastfeeding parent. The breastfeeding parent will continue to receive usual care as part of HB4HNEKids. The secondary carers/support persons messages have been specifically designed for the secondary carers/support persons, thus the set of 29 messages (i.e. approximately 1 message per week) will be sent to the secondary carer/support persons, that are different from those received by the breastfeeding parent. • Experimental condition 2: an intensive breastfeeding message package will be developed that aims to address key barriers to breastfeeding aligned to each component of the Behaviour Change Wheel. Breastfeeding text, including an additional 8 text messages in total. Breastfeeding text messages will be sent regularly in addition to the existing messages (i.e. approximately 1 additional message every 3 weeks) for the first 6 months of the child’s life or until the parent stops breastfeeding. Parents will be randomised to one of four groups: Group A will receive experimental condition 1 only. Group B will receive experimental condition 2 only. Group C will receive both experimental conditions 1 and 2. Group D is the control group (existing breastfeeding messages). Adherence for each group will be monitored via project records and link clicks.