Implementing behavioural science in an infant feeding website: testing the usability and acceptability of ifeed

By Naomi Bartle – Centre for Advanced Behavioural Sciences, Coventry University, UK  

The UK has one of the lowest rates of breastfeeding in the World, with less than 1% of babies receiving exclusive breastmilk for the first 6 months of life as recommended by the World Health Organisation.   Low breastfeeding rates lead to increased risk of significant maternal and infant disease and mortality.  Most mothers report stopping breastfeeding before they wanted to, having encountered physical and emotional difficulties, which often could have been prevented with appropriate information and support. On the other hand, the majority of babies receive at least some formula milk, and parents report a need for information about how to prepare and feed bottles of formula milk in order to minimise the health risks to the baby.

Digital behaviour change interventions have considerable potential for bolstering the support available to parents.  Round the clock support is vital for parents who may feel at their most desperate at 2am.  Digital tools also offer the opportunity to provide consistent, evidence-based information. This is something that parents tell us is not always available from midwives and health visitors who have limited time, and may not be trained in specialist breastfeeding support.  However, in our review of popular infant feeding websites we found that while many offer plenty of clinical information, they tend to miss information about the social and psychological barriers to safe and responsive infant feeding, and rarely utilise theory from behavioural science.

Ifeed has been developed to provide comprehensive support for all parents, including information to promote breastfeeding and enable safe and responsive formula feeding when required.  Behaviour change techniques have been chosen to address each of the six elements of the COM-B model, and are provided using a reassuring and supportive tone.  Text information appears alongside graphics, animations, and videos of other parents’ experiences in order to reinforce the key messages.  We know that infant feeding can be a divisive issue, so the information is centred around a key universal message of promoting loving relationships (bonding) between infants and their caregivers.

Before launching the site, we ran a two-phase usability and acceptability study, recently presented at the Division of Health Psychology conference. We wanted to ensure that the site was easy to use and ‘liked’ enough because we know that these issues are critical for high usage of the site, in turn critical for the site to have any impact on parents.  In the first stage, parents and expectant parents took part in a ‘think aloud’ study where they reviewed the site for the first time in the presence of a researcher and were encouraged to speak aloud about what they were thinking and doing. This didn’t reveal any difficulties with navigation, and all participants were positive about the look and feel of the site.

In the second stage, we recruited women who were over 32 weeks of pregnancy or had a baby under six weeks via their GP practice, and invited them and a supporter to view the site and complete and online questionnaire.  From a 16% response rate, we had quite mixed findings; all mean scores were over the midpoint, indicating responses were more positive than negative.  However, we found that individual scores were likely to be more extreme – either very positive (usually if they were in favour of breastfeeding) – or very negative (usually if bottle feeding).  We are currently exploring these results further and trying to identify how we can make the site more appealing to bottle feeding parents, without infringing guidelines around the protection of breastfeeding.

Questions:

• How can we tell if a digital intervention is acceptable enough? IS a mean score above a midpoint acceptable enough?
• Are digital interventions likely to be effective at promoting behaviour change for subjects that are particularly contentious or emotional?
• Is it possible to tailor digital interventions without requiring users to register?

Bio:

Dr Naomi Bartle (@DrNaomiBartle) is Research Fellow in the Centre for Advanced Behavioural Sciences at Coventry University.  Naomi’s research interests are around parenthood and nutrition and she is leading a number of projects related to developing digital (and non-digital) interventions to support parents with infant feeding.   The development of ifeed was supported by and MRC PHIND grant, and the intervention is available freely at http://ifeedproject.co.uk.