Designing and developing a mobile app (BeBo) in a randomized controlled trial study to promote breastfeeding among Vietnamese mothers.

BACKGROUND: Breastfeeding should begin as soon as possible after birth and continue exclusively to 6 months of age. In Vietnam, as in many other countries, breastfeeding is decreasing because of modern lifestyles and the promotion of infant formula. It is important to provide mothers, family members, and the community with the knowledge and strategies to improve breastfeeding rates. Smartphones are almost ubiquitous in Vietnam and of the potential to provide information about breastfeeding. This study aimed to document the process of designing and developing a mobile app to increase breastfeeding rates in Vietnamese women. METHODS: We used a four-step mixed methods approach with a literature review, formative research (22 in-depth interviews and 49 self-administered online questionnaires), and testing of prototype apps (3 focus groups discussion and external experts). Formative research and focus group discussion involved 99 participants. Finally, the revisions of the app were tested. All of the formative research was undertaken in Hanoi in 2019-2020. Target behaviors followed by key determinants, to improve breastfeeding self-efficacy were studied and this information was then applied in developing the messages and library content. Barriers and facilitators to breastfeeding were identified from literature reviews and qualitative research. The messages were targeted at not only mothers but also included fathers, mothers-in-law, or families. RESULTS: Mothers were mostly concerned about the initiation of breastfeeding, preventing and reducing difficulties encountered during breastfeeding, and nutrition for breastfeeding mothers. Mental health and well-being in the postnatal period are also concerns. Three key features to be included in the app were identified from the formative research: (1) notifications; (2) an information library; and (3) a searching function. The research found that the app should be installed during pregnancy rather than after delivery (81% vs 17%, respectively). Notifications that convey breastfeeding messages should be sent 2-3 times per week. CONCLUSION: The development of the app followed a best practice approach, including the involvement of stakeholders and grounding in behavior change theory. The next step is to evaluate the effectiveness of the BeBo mobile app in a well-conducted randomized controlled trial. TRIAL REGISTRATION: ACTRN12619000531112.

Effect of a Mobile Application on Breastfeeding Rates Among Mothers Who Have Cesarean Deliveries: A Randomized Controlled Trial.

Aim: Cesarean section often translates to negative impacts on breastfeeding rates. This study aims to evaluate the effect of a mobile application on breastfeeding outcomes among mothers who had cesarean sections using a randomized controlled trial in Vietnam in 2020-2022. Methods: A triple-blinded randomized trial of a mobile application was conducted. The mobile application was tailored to a Vietnamese cultural context with two separate versions, one for the intervention and one for the control. The intervention group version auto-generated three messages per week and linked with the information in the application's library content to improve breastfeeding practices. In contrast, the control group's version of the application sent messages on related general maternal and child health care. Pregnant mothers were recruited during their antenatal visits and randomly assigned to one of the two groups. Outcomes of interest included early initiation of breastfeeding and exclusive breastfeeding rates. Results: A total of 293 in the intervention group and 275 mothers in the control who had undergone cesarean sections were included in the analyses. Significant increases were observed in the intervention group for early initiated breastfeeding within 2 hours (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.01-2.24) and exclusive breastfeeding during hospital stay (aOR = 1.60, 95% CI: 1.03-2.48). Conclusion: Our results support the use of a theory-based and designed mobile phone application as a part of a promising intervention to improve breastfeeding outcomes among mothers who have cesarean sections.

COVID and Gender: A Narrative Review of the Asia-Pacific Region.

The COVID-19 pandemic has been the largest infectious disease epidemic to affect the human race since the great influenza pandemic of 1918-19 and is close to approaching the number of deaths from the earlier epidemic. A review of available data and the numerous currently available studies on COVID-19 shows that the rate of clinical cases is about 10% greater in females than males in Asia. However, the number of deaths is greater in males than in females. Women are more likely to experience the psychological effects of COVID-19 during and after acute infections. A significant proportion of acute COVID-19 infections continue and their prolonged symptoms have been reported. Further studies are needed, including detailed serology, to measure and monitor the incidence of COVID-19. The pandemic has had a widespread impact on broader societies including shortages of food, lockdowns and isolation. The number of orphans in developing countries has increased. Women have had to bear the major impacts of these community effects. More research is required to develop better vaccines acting against new strains of the virus and to develop systems to distribute vaccines to all people.

Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App.

Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.

Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities.

City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka's pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.