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Employing a User-Centered Design to Engage Mothers in the Development of a mHealth Breastfeeding Application

Jefferson, Urmeka T. PhD, RN; Zachary, Iris PhD, MSHI, CTR; Majee, Wilson PhD, MPH, MBA

CIN: Computers, Informatics, Nursing: October 2019 - Volume 37 - Issue 10 - p 522–531
doi: 10.1097/CIN.0000000000000549

Breastfeeding has numerous health benefits; however, many mothers do not continue breastfeeding to the recommended 6 months of age. Breastfeeding support after discharge from the hospital is often lacking in the communities with the greatest need. Therefore, the Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Two phases of stakeholder and user studies were conducted. Phase 1 involved concept generation, prototype development, and usability testing. Phase 2 focused on prototype redesign and usability testing. We used a descriptive mixed-method approach with data collected using a demographic questionnaire, System Usability Scale, exit survey, and focus groups. Final features of the Mother's Milk Connection application included resources and education, peer support, automated activity tracking, and professional support via video conference. Stakeholder and user engagement indicated the integration of four distinct features is acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed.

Author Affiliations: Sinclair School of Nursing (Dr Jefferson), Health Management and Informatics (Dr Zachary), and School of Health Professions (Dr Majee), University of Missouri, Columbia.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Phase 1 of this project was supported by grant R24HS022140 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Phase 2 was supported by funding from University of Missouri Institute for Clinical and Translational Science.

Corresponding author: Urmeka T. Jefferson, PhD, RN, S416 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211 (

Online date: August 14, 2019

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