Using a Mobile Health Application by Peer Counselors to Promote Exclusive Breastfeeding in Rural India – A Training Curriculum

Background: Despite strong evidence about the benefits of exclusive breastfeeding (EBF), rates have remained relatively unchanged over the past two decades in low-middle income countries. One strategy for increasing EBF is through community-based programs that use Peer Counselors (PCs) for education and support. The use of mobile health (mHealth) applications is gaining increasing applicability in these countries.

Research Aim: The present article describes our curriculum in the state of Karnataka, India for supporting new mothers to exclusively breastfeed using a mHealth application in rural India.

Methods: Twenty-ve women from the community were trained to be PCs and to use a mHealth application to conduct breastfeeding counseling. The three-day training was based on the WHO breastfeeding course, translated and adapted to the local culture. The curriculum was validated by twelve nursing and obstetric experts. A pre-post evaluation of breastfeeding knowledge, self-efficacy, and skills was evaluated with a 30-item survey. The usability of the mHealth application was assessed post-training with a Usability Scale for Mobile Breastfeeding Education App.

Results: We observed a significant increase in the mean scores for knowledge (P <.0001) and skills (P=.0006) from pre to post-training. The age of the PCs and their own breastfeeding experience correlated significantly with the acquisition of knowledge and skills. The mHealth app showed high usability scores.

Conclusions: The culturally adapted curriculum was effective in training women from a rural setting in the acquisition of EBF knowledge and skills and in the use of a mHealth application to support their training.