Use of and Attitudes About Telelactation Services among New Parents.
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ABSTRACT:
SUBMITTER: Uscher-Pines L
PROVIDER: S-EPMC10079243 | biostudies-literature | 2023 Apr
REPOSITORIES: biostudies-literature
Publications
Use of and Attitudes About Telelactation Services among New Parents.
Uscher-Pines Lori L Kapinos Kandice A KA Mehrotra Ateev A Demirci Jill J Ray Kristin N KN Alvarado Gabriela G DeYoreo Maria M
Telemedicine journal and e-health : the official journal of the American Telemedicine Association 20220805 4
<b><i>Background:</i></b> We conducted a national, cross-sectional survey among new parents to explore use and acceptability of telelactation. <b><i>Methods:</i></b> Recruitment occurred between October 2021 and January 2022 on Ovia's parenting mobile phone application. Poststratification survey weights were used, and logistic and linear regression models estimated associations between demographics and telelactation use. <b><i>Results:</i></b> Among 1,617 respondents, 33.8% had at least one tele ...[more]
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Project description:BackgroundBreastfeeding offers many medical and neurodevelopmental advantages for birthing parents and infants; however, the majority of parents stop breastfeeding before it is recommended. Professional lactation support by the International Board Certified Lactation Consultants (IBCLCs) increases breastfeeding rates; however, many communities lack access to IBCLCs. Black and Latinx parents have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. Virtual "telelactation" consults that use two-way video have the potential to increase access to IBCLCs among disadvantaged populations. We present a protocol for the digital Tele-MILC trial, which uses mixed methods to evaluate the impact of telelactation services on breastfeeding outcomes. The objective of this pragmatic, parallel design randomized controlled trial is to assess the impact of telelactation on breastfeeding duration and exclusivity and explore how acceptability of and experiences with telelactation vary across Latinx, Black, and non-Black and non-Latinx parents to guide future improvement of these services.Methods2400 primiparous, pregnant individuals age > 18 who intend to breastfeed and live in the USA underserved by IBCLCs will be recruited. Recruitment will occur via Ovia, a pregnancy tracker mobile phone application (app) used by over one million pregnant individuals in the USA annually. Participants will be randomized to (1) on-demand telelactation video calls on personal devices or (2) ebook on infant care/usual care. Breastfeeding outcomes will be captured via surveys and interviews and compared across racial and ethnic groups. This study will track participants for 8 months (including 6 months postpartum). Primary outcomes include breastfeeding duration and breastfeeding exclusivity. We will quantify differences in these outcomes across racial and ethnic groups. Both intention-to-treat and as-treated (using instrumental variable methods) analyses will be performed. This study will also generate qualitative data on the experiences of different subgroups of parents with the telelactation intervention, including barriers to use, satisfaction, and strengths and limitations of this delivery model.DiscussionThis is the first randomized study evaluating the impact of telelactation on breastfeeding outcomes. It will inform the design and implementation of future digital trials among pregnant and postpartum people, including Black and Latinx populations which are historically underrepresented in clinical trials.Trial registrationClinicalTrials.gov NCT04856163. Registered on April 23, 2021.
| S-EPMC8721475 | biostudies-literature
Project description:ImportanceThere are substantial disparities in breastfeeding rates by race and ethnicity. Telelactation services that connect parents to lactation consultants via video are increasingly available and may reduce inequities in breastfeeding support; however, there is limited evidence on effectiveness.ObjectiveTo assess the impact of video telelactation services on breastfeeding duration and exclusivity across a racially and ethnically diverse population of parents.Design, setting, and participantsThis digital randomized clinical trial was conducted across 39 states. Eligible participants were aged 18 years or older, were in their third trimester of pregnancy with their first child, and intended to breastfeed. Participants were recruited through pregnancy apps from July 2021 to December 2022 and followed up through 24 weeks post partum. Analyses were completed from December 2023 to June 2024.InterventionPregnant individuals were randomized 1:1 to the treatment arm, which received access to a smartphone app with on-demand access to lactation consultants 24 hours a day via video visits, or to the control arm, which received an infant care e-book.Main outcomes and measuresAny breastfeeding and any infant formula use at 24 weeks post partum and time to breastfeeding cessation. The intention-to-treat analysis used regression models to estimate unadjusted effects and effects adjusted for baseline characteristics.ResultsA total of 2108 participants were randomized, and 1911 were analyzed for primary outcomes. The mean (SD) age at the time of recruitment was 29.61 (5.37) years, and 707 participants (37.0%) had a household income of less than $55 000. In all, 611 participants (32.0%) identified as Black, 678 (35.5%) as Latinx, and 622 (32.5%) as races and/or ethnicities other than Black or Latinx. Among treatment arm participants, 466 (48.8%) used telelactation services. In intention-to-treat analyses, the proportion of all participants who reported any breastfeeding at 24 weeks was 674 (70.6%) in the treatment group and 639 (66.8%) in the control group (adjusted difference, 3.6 percentage points; 95% CI, -0.5 to 7.6 percentage points; P = .08), and the proportion with exclusive breastfeeding at 24 weeks was 447 (46.9%) in the treatment arm and 421 (44.1%) in the control arm (adjusted difference, 2.4 percentage points; 95% CI, -1.9 to 6.8 percentage points; P = .28). Differences were significant among Black participants. The proportion of Black participants who reported any breastfeeding at 24 weeks was 196 of 301 (65.1%) in the treatment arm and 178 of 310 (57.4%) in the control arm (adjusted difference, 7.5 percentage points; 95% CI, 0.2-14.8 percentage points; P = .045) and who reported breastfeeding exclusively at 24 weeks was 128 of 300 (42.7%) in the treatment arm and 105 of 310 (33.9%) in the control arm (adjusted difference, 9.2 percentage points; 95% CI, 1.4-16.9 percentage points; P = .02).Conclusions and relevanceIn this randomized clinical trial, telelactation services had no significant effect on breastfeeding rates among participants overall, but significant improvements were found among Black individuals. The results suggest that telelactation services could be a component of a comprehensive strategy to reduce racial disparities in breastfeeding rates.Trial registrationClinicalTrials.gov Identifier: NCT04856163.
| S-EPMC11868977 | biostudies-literature
Project description:Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communities have about mental health and service use for anxiety and depression in children. We used thematic analysis to analyze interview data from 15 Latinx parents who expressed concerns about their child's (age 6-13) worry or sadness. Analyses revealed that Latinx parents often have difficulty identifying mental health problems, report stigma about mental health problems and help-seeking and want more information about how they can help their children. Although Latinx parents report significant mental health and treatment-seeking stigma, the majority were open to seeking mental health services for their children or were already receiving services. Findings suggest that stigma although prevalent, may not deter service utilization for some Latinx families. Implications for community health and future research are discussed.
| S-EPMC10575228 | biostudies-literature
Project description:BackgroundChildren of parents with mental illness have a higher risk of developing mental health problems when compared with the general population. Therefore, families with parents with mental illness are a suitable target group for selective prevention. In order to plan and evaluate the health economic consequences of preventive interventions for this target group, data on the societal costs related to parenthood under the condition of mental disorders are needed. To date, within Germany there has been a lack of research evaluating the costs of mental health treatment and use of social services by children and adolescents with parents with mental illness.MethodsAs part of a multicentre randomised controlled trial, use and costs of health and social services were assessed for a sample of 332 children and adolescents with parents with mental illness in six regions of Germany. Service use at baseline was assessed by the German version of the Children and Adolescent Mental Health Service Receipt Inventory. Costs were calculated for 12 months based on diagnosis and service user status and described separately. Cost drivers were identified by means of a two-part regression model.ResultsTotal mean costs for 12 months for the total sample amount of € 3736.35 (95% CI: € 2816.84-4813.83) per person. Children with a psychiatric diagnosis generated a total of € 5691.93 (95% CI: € 4146.27-7451.38) of costs per person, compared to € 1245.01 (95% CI: € 657.44-1871.49) for children without a psychiatric diagnosis. The logit part indicates significant odds ratios for individual functioning and diagnosis of the child as well as for family functioning. The linear part reveals that increasing individual functioning in the child is related to decreasing costs.ConclusionsChildren of families with parents with mental illness use a broad spectrum of mental health care, school-based support and youth welfare services even if they are not yet diagnosed as having a mental disorder. Further research should examine whether these institutions are sufficiently qualified and interlinked to meet the support needs of this vulnerable group. Trial registration The study was registered at the 07/10/2014 before the start of data collection (04/11/2014) at the German clinical trials register (Deutsches Register Klinischer Studien, DRKS, nr: DRKS00006806, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006806 ).
| S-EPMC7897390 | biostudies-literature
Project description:The New Vaccinations of Infants in Practice online survey in seven countries evaluated vaccination-related attitudes and concerns of parents of infants and health care providers (HCPs) who provide pediatric medical care. The survey showed that HCPs and parents were open to adding new vaccines to the immunization schedule, even if it requires co-administration with current vaccines or introduction of new office visits. Parental disease awareness campaigns would be helpful to achieve widespread acceptance of changes to vaccination schedules. In addition, HCPs would ideally provide disease education to parents to accompany recommendations for a new vaccine.
| S-EPMC3606510 | biostudies-literature
Project description:BackgroundBreastfeeding attitudes are known to influence infant feeding but little information exists on the prenatal breastfeeding attitudes of parents. The purpose of this study was to describe Finnish parents' prenatal breastfeeding attitudes and their relationships with demographic characteristics.MethodsThe electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed and 172 people (123 mothers, 49 fathers) completed the study. The data were analysed using factor analysis and nonparametric methods.ResultsBreastfeeding was regarded as important, but 54% of the respondents wanted both parents to feed the newborn. The mean rank values of breastfeeding attitudes differed significantly when parity, gender, education, age, breastfeeding history and level of breastfeeding knowledge were considered. The respondents who were expecting their first child, were 18-26 years old or had vocational qualifications or moderate breastfeeding knowledge had more negative feelings and were more worried about breastfeeding than respondents who had at least one child, had a higher vocational diploma or academic degree or had high levels of breastfeeding knowledge. Respondents with high levels of breastfeeding knowledge did not appear concerned about equality in feeding.ConclusionsBoth mothers and fathers found breastfeeding important. A father's eagerness to participate in their newborn's life should be included in prenatal breastfeeding counselling and ways in which to support breastfeeding discussed. Relevant information about breastfeeding should focus on the parents who are expecting their first child, those who are young, those with low levels of education or those who have gaps in breastfeeding knowledge, so that fears and negative views can be resolved.
| S-EPMC3003624 | biostudies-literature
Project description:ObjectiveVeterans, especially those residing in rural areas, continue to underutilize mental health care. This longitudinal study assessed attitudes relevant to seeking mental health care services from the Veterans Health Administration (VHA) over 12 months, adjusting for residence.MethodsA questionnaire addressing attitudes, sociodemographic factors, residence, place identity, perceived health status and needs, and structural barriers was administered by telephone to 752 veterans with previous VHA service use. Service use data were obtained from a VHA database.ResultsIn adjusted models, four attitudes were significantly associated with underuse of VHA mental health care (no use vs. any use; no use vs. nonsustained use vs. sustained use). Higher levels of mistrust of others (adjusted odds ratio [AOR]=1.06, p=0.046), emotional stoicism (AOR=1.08, p=0.003), belief in the self-resolving nature of mental health problems (AOR=1.91, p=0.015), and belief in the efficacy of religious counseling for such problems (AOR=1.09, p=0.022) were associated with no subsequent service use versus any use. Place identity (suburban), older age, and greater need were associated with greater odds of VHA use. For the comparison of no use versus sustained use, women had lower odds of no use (AOR=0.49, p<0.001); similarly, women had lower odds of nonsustained use versus sustained use (AOR=0.45, p<0.001).ConclusionsThe association of potentially modifiable attitudes with underuse of VHA mental health services suggests that attitudes offer useful targets for efforts to increase mental health care use. That these attitudes were influential regardless of residence suggests that programs addressing attitudinal barriers can be broadly targeted.
| S-EPMC8638372 | biostudies-literature
Project description:BACKGROUND:Telelactation services connect breastfeeding mothers to remotely located lactation consultants through audio-visual technology and can increase access to professional breastfeeding support in rural areas. OBJECTIVE:The objective of this study was to identify maternal characteristics associated with the demand for and use of telelactation and to describe visit characteristics. METHODS:We conducted a descriptive study within the context of a randomized controlled trial. Participant survey data and vendor electronic medical record data were used to assess video call characteristics like timing, duration, topics discussed, and participant satisfaction. Recruitment occurred from 2016-2018 at a rural critical access hospital in Pennsylvania. The 102 women enrolled in the study were given access to unlimited, on-demand video calls with lactation consultants through a mobile phone app and were tracked for 12 weeks following their postpartum hospitalization. RESULTS:A total of 94 participants out of 102 recruits (92%) participated in the final, 12-week survey assessment were included in the analysis. Of those, 47 (50%) participants reported participating in one or more video calls, and 31 (33%) completed one or more calls that included a substantive discussion of a breastfeeding challenge. Participants who used telelactation (21/31, 68%; P=.02) were more likely to be working at 12 weeks postpartum compared to others (26/63, 41%), were less likely (12/31, 39%; P=.02) to have prior breastfeeding experience on average compared to nonusers (41/63, 65%), and were less likely to have breastfed exclusively (16/31, 52%; P<.001) prior to hospital discharge compared to mothers who didn't use telelactation services (51/63, 81%). Most video calls (58/83, 70%) occurred during the infant's first month of life and 41% (34/83) occurred outside of business hours. The most common challenges discussed included: breast pain, soreness, and infection (25/83, 30%), use of nipple shields (21/83, 25%), and latch or positioning (17/83, 24%). Most telelactation users (43/47, 91%) expressed satisfaction with the help received. CONCLUSIONS:Telelactation is an innovation in the delivery of professional breastfeeding support. This research documents both demand for and positive experiences with telelactation in an underserved population. TRIAL REGISTRATION:ClinicalTrials.gov NCT02870413; https://clinicaltrials.gov/ct2/show/NCT02870413.
| S-EPMC6751090 | biostudies-literature
Project description:Cervical cancer mortality is high among Peruvian women of reproductive age. Understanding barriers and facilitators of cervical cancer screening and treatment could facilitate development of contextually-relevant interventions to reduce cervical cancer incidence and mortality. From April to October 2019, we conducted a cross-sectional survey with 22 medical personnel and administrative staff from Liga Contra el Cancer, in Lima, Peru. The survey included structured and open-ended questions about participants' roles in cervical cancer prevention and treatment, perceptions of women's barriers and facilitators for getting screened and/or treated for cervical cancer, as well as attitudes towards adopting new cervical cancer interventions. For structured questions, the frequency of responses for each question was calculated. For responses to open-ended questions, content analysis was used to summarize common themes. Our data suggest that the relative importance and nature of barriers that Peruvian women face are different for cervical cancer screening compared to treatment. In particular, participants mentioned financial concerns as the primary barrier to treatment and a lack of knowledge or awareness of human papillomavirus and/or cervical cancer as the primary barrier to screening uptake among women. Participants reported high willingness to adopt new interventions or strategies related to cervical cancer. Building greater awareness about benefits of cervical cancer screening among women, and reducing financial and geographic barriers to treatment may help improve screening rates, decrease late-stage diagnosis and reduce mortality in women who have a pre-cancer diagnosis, respectively. Further studies are needed to generalize study findings to settings other than Lima, Peru.
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Project description:In NSW, Australia, the views of primary-school aged children and their parents in regard to the importance of nutrition education at school are unclear. The aim of the current study was to explore children's knowledge of nutrition and eating habits and to identify gaps that future school nutrition education programs could target. Students aged 9 to 12 years and their parents (n = 21 dyads) were invited to participate in semi-structured interviews, complete a nutrition knowledge questionnaire, and perform a "healthy-unhealthy" food sorting task in a University food laboratory. Among the children, nutrition knowledge scores concerning "serves & portions" of common foods were lowest, identifying a gap in knowledge related to portion size. All children categorized fruits, vegetables, cola, and water correctly as "healthy" or "unhealthy" in the sorting task, but not for the sausage and muesli bar, suggesting that further support categorising processed foods may be needed. The interviews indicated that parents do actively try to teach their children about nutrition, although they reported feeling uncertain about their own level of nutrition knowledge. Children and parents indicated that there is very little nutrition education in school and more is needed. This research could be used to inform future curriculum components related to nutrition education for primary school children.
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