Text Messaging Programs for Breastfeeding

Overseen By Lydia Furman, MD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Lydia Furman

Disqualifiers: Formula feeding only, no mobile phone

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two text messaging programs, Team2BF and Text4baby, to determine which better supports African-American/Black moms in starting and continuing breastfeeding. One program sends frequent messages focused solely on breastfeeding support, while the other covers various maternal health topics, including breastfeeding. The goal is to increase breastfeeding rates among African-American/Black women, who traditionally face more challenges in this area. Expectant women with a mobile phone for texting, who plan to breastfeed and receive care at specific medical centers, are a good fit for this trial. As an unphased trial, this study offers a unique opportunity to contribute to important research that could enhance breastfeeding support for African-American/Black mothers.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these text messaging programs are safe for promoting breastfeeding?

Research has shown that text messaging programs for breastfeeding, such as Team2BF, are safe and well-received by users. In a study with 353 pregnant women, these programs significantly increased breastfeeding rates. A pilot program specifically for African-American/Black mothers found the text messages practical, welcomed, and helpful.

These programs primarily provide support and information, with no serious side effects reported. The trial's "Not Applicable" phase status indicates it is not testing a new drug or medical procedure, suggesting minimal risk. Overall, text messaging support for breastfeeding is considered a safe way to help mothers continue breastfeeding. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these text messaging programs because they offer personalized and timely breastfeeding support directly to mothers' phones. Team2BF stands out by delivering frequent, breastfeeding-specific messages from late pregnancy through the first year postpartum, focusing solely on breastfeeding without diluting the message with other topics. On the other hand, Bright By Text provides a broader range of maternal and child health information, including breastfeeding content, but with a slightly less intense focus. Both programs aim to enhance breastfeeding initiation and duration by providing accessible support, potentially overcoming barriers that traditional in-person or written resources face.

What evidence suggests that this trial's text messaging programs could be effective for promoting breastfeeding?

Research shows that text messaging programs can improve breastfeeding rates. Studies have found that sending text messages during pregnancy and after birth significantly increases the number of mothers who breastfeed exclusively. Specifically designed messages to support breastfeeding have been particularly successful. In this trial, the Team2BF program is one option being tested, sending frequent, supportive messages to build on this evidence and help more mothers breastfeed successfully. Another program, Bright By Text, will also be evaluated, providing messages on various maternal and child health topics, including breastfeeding. ^{1 6 7 8 9}

Who Is on the Research Team?

Lydia Furman, MD

Principal Investigator

University Hospitals Cleveland Medical Center

Are You a Good Fit for This Trial?

The TOPS trial is for African-American/Black expecting and delivered women interested in breastfeeding. It aims to support these mothers by comparing two text message programs: TEAM2BF, designed specifically to promote breastfeeding, versus Text4baby, a national maternal health program.

Inclusion Criteria

Daily access to a mobile phone with text message capabilities

English speaking

Receive care at Ahuja Midtown or MAC1200

Exclusion Criteria

No mobile phone with text capability

Committed to feeding formula only to their infant

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive breastfeeding-supportive text messages from 28 weeks gestation through delivery, daily through 2 weeks postpartum, weekly from 2 to 10 weeks, and then monthly to one year

Up to 1 year

Follow-up

Participants are monitored for the effectiveness of the texting program on breastfeeding rates

6 months postpartum

What Are the Treatments Tested in This Trial?

Interventions

• Team2BF
• Text4baby

Trial Overview This study tests whether the TEAM2BF text messaging program can increase breastfeeding rates among participants compared to those receiving messages from Text4baby. Up to 80 mothers at UHCMC will be enrolled to receive these supportive texts.

How Is the Trial Designed?

Group I: Team2BF Experimental Treatment 1 Intervention

Team2BF includes 3-4 breastfeeding-supportive messages per time interval, sent weekly from 28 weeks gestation through delivery, daily through 2 weeks postpartum, weekly from 2 to 10 weeks, and then monthly to one year. Other maternal health topics are not addressed.

Group II: Bright By Text Active Control 1 Intervention

Bright By Text sends 2-4 messages per week from the first trimester through and beyond one year postpartum about a wide range of maternal and child health topics as outlined on their website; 8 messages are specifically about breastfeeding.

Who Is Running the Clinical Trial?

Lydia Furman

Lead Sponsor

Trials

2

Recruited

320+

Case Western Reserve University

Lead Sponsor

Trials

314

Recruited

236,000+

University Hospitals Cleveland Medical Center

Collaborator

Trials

348

Recruited

394,000+

Published Research Related to This Trial

A randomized controlled trial with 353 pregnant women showed that text message interventions significantly increased exclusive breastfeeding rates, with 43.4% in the intervention group compared to 15.3% in the control group at 6 months postpartum.

The text message intervention not only improved breastfeeding practices but also reduced the risk of diarrhea in infants by 55%, highlighting its effectiveness in promoting maternal and child health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tailored text messages to improve breastfeeding practices in Yangon, Myanmar: the M528 individually randomized controlled trial. Hmone, MP., Li, M., Agho, KE., et al.[2023]

The automated text messaging intervention, MumBubConnect, significantly improved exclusive breastfeeding rates, with only a 6% decrease in the intervention group compared to a 14% decrease in the comparison group over 8 weeks.

Participants in the intervention group showed better coping strategies and were less likely to rely on emotion-focused coping, indicating that the text messaging service effectively supported mothers in managing breastfeeding challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can a text message a week improve breastfeeding? Gallegos, D., Russell-Bennett, R., Previte, J., et al.[2021]

The LATCH study, a randomized controlled trial, demonstrated that text messaging can effectively enhance communication between breastfeeding peer counselors and mothers, providing timely support during the critical postpartum period.

Key topics discussed through text messages included breastfeeding mechanics, social support, and addressing common breastfeeding challenges, indicating that this method can significantly improve maternal access to breastfeeding assistance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A qualitative analysis of text message conversations in a breastfeeding peer counselling intervention. Martinez-Brockman, JL., Harari, N., Goeschel, L., et al.[2021]

The Lactation Advice thru Texting Can Help intervention significantly improved early postpartum contact between mothers and peer counselors, with 86.6% of mothers in the texting group contacting their counselors within 48 hours of delivery compared to only 27.3% in the control group.

While exclusive breastfeeding (EBF) rates at 2 weeks postpartum were higher in the texting group (50%) compared to the control group (31.8%), the difference was not statistically significant, suggesting that the texting intervention may help mothers meet their breastfeeding goals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and acceptability of a text message intervention used as an adjunct tool by WIC breastfeeding peer counsellors: The LATCH pilot. Harari, N., Rosenthal, MS., Bozzi, V., et al.[2020]

A formative assessment involving 42 parents and nutrition experts led to the creation of 16 tailored SMS messages aimed at supporting breastfeeding for expectant couples in Tigray, Ethiopia.

The intervention showed high engagement, with 87% of parents receiving multiple messages and nearly all fathers and 97% of mothers reading them, indicating strong interest in continued SMS support for infant feeding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Co-design and implementation of a mHealth intervention targeting fathers and mothers to improve breastfeeding. Gebremariam, KT., Mulugeta, A., Gallegos, D.[2023]

The text messaging intervention significantly reduced the time it took for participants to contact their breastfeeding peer counselors (BFPCs), with an odds ratio of 2.93, indicating nearly three times higher likelihood of early contact compared to the control group.

However, the intervention did not significantly improve exclusive breastfeeding (EBF) rates at 2 weeks or 3 months postpartum, with an odds ratio of 1.26, suggesting that while communication was enhanced, it did not translate into better breastfeeding outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of the Lactation Advice Through Texting Can Help (LATCH) Trial on Time to First Contact and Exclusive Breastfeeding among WIC Participants. Martinez-Brockman, JL., Harari, N., Segura-Pérez, S., et al.[2019]

In a study involving low-income, first-time mothers, increased use of breastfeeding smartphone apps did not lead to higher rates of breastfeeding initiation or sustained breastfeeding compared to lower app usage, with initiation rates of 84.1% versus 78.2% respectively.

Despite the lack of impact on breastfeeding rates, both groups preferred technology-based resources for breastfeeding support, suggesting that further development of such interventions could still be beneficial for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Novel Breastfeeding Smartphone Applications on Breastfeeding Rates. Griffin, LB., López, JD., Ranney, ML., et al.[2022]

The MILK SMS intervention, designed to support breastfeeding, was well-received by participants, with many reporting increased confidence and perseverance in breastfeeding despite challenges, indicating its efficacy in addressing perceived insufficient milk supply.

Participants appreciated the personalized features of the MILK system and suggested improvements, such as extending support beyond 8 weeks and tailoring content to individual breastfeeding experiences, highlighting the importance of customization in digital health interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial. Demirci, JR., Suffoletto, B., Doman, J., et al.[2021]

The text message-based communication platform did not significantly improve overall breastfeeding exclusivity rates at 6 weeks postpartum compared to usual care, with rates of 48.4% in the intervention group versus 41.3% in the control group.

However, among Black participants, those receiving the intervention had 2.6 times higher odds of exclusively breastfeeding compared to their counterparts in the control group, indicating a potential benefit in reducing racial disparities in breastfeeding outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text Message-Based Breastfeeding Support Compared With Usual Care: A Randomized Controlled Trial. Bender, W., Levine, L., Durnwald, C.[2022]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38056353/

Text messaging interventions for breastfeeding outcomes Text messaging interventions that covered antenatal and postnatal periods, delivered weekly were most effective in improving the exclusive breastfeeding rate.

2. sciencedirect.com sciencedirect.com/science/article/pii/S0020748923002122

Text messaging interventions for breastfeeding outcomes Overall, we found that text messaging interventions significantly improved the exclusive breastfeeding rates and breastfeeding self-efficacy, but not any ...

3. withpower.com withpower.com/trial/phase-increased-breastfeeding-6-2024-68226

Text Messaging Programs for Breastfeeding Trial Overview This study tests whether the TEAM2BF text messaging program can increase breastfeeding rates among participants compared to those receiving ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7293063/

Effectiveness of Internet-Based Electronic Technology ... This study demonstrated a variety of internet-based e-technologies that professionals can use to promote, educate, and support breastfeeding women.

5. sciencedirect.com sciencedirect.com/science/article/pii/S0002916523005051

Tailored text messages to improve breastfeeding practices ... We found that text messages promoting appropriate breastfeeding practices led to significantly higher exclusive breastfeeding rates in the intervention group ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11238827/

A Pilot Breastfeeding-Supportive Texting Program for ... A new breastfeeding-supportive text messaging program intended for AA/B mothers appears feasible, acceptable, informative, and relevant.

7. internationalbreastfeedingjournal.biomedcentral.com internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-024-00693-2

A randomized controlled, trial on effects of mobile phone text ... We conducted a trial to determine whether text messaging plus motivational interviewing prolonged exclusive breastfeeding during the first six months of life.

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1871519222001135

Use of telelactation interventions to improve breastfeeding ... Professional and peer support are key to improving breastfeeding rates; they can improve the rate of nursing mothers by 16 % in comparison to usual care [9].

9. jamanetwork.com jamanetwork.com/journals/jama/fullarticle/2832390

Interventions to Support Breastfeeding: Updated Evidence ... There was limited and mixed evidence on the effectiveness of breastfeeding support interventions on infant health outcomes (10 trials [n = 6592]) ...