JMIR (Journal of Medical Internet Research)

Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. This study is aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. A user-centered design process with an agile development methodology was used.

The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby’s design and development, including the app’s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs that supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months postpartum.

BEST4Baby’s usability from the PCs’ perspective was assessed using the translated System Usability Scale (SUS). The findings of this study align with best practices in user-centered design to address EBF barriers. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs