Adaptation and Evaluation of the Lactation Advice Through Texting Can Help Intervention

About This Grant

ABSTRACT There are persistent subgroup differences in the rate of exclusive breastfeeding (EBF) in the United States (U.S.). While no subgroup has met the Healthy People 2030 target of 42.4% for EBF to 6 months, the rates are particularly low for Hispanic infants (25.9%) and Black infants (24.4%), compared to White (29.3%) and Asian (30.2%) infants. The benefits of breastfeeding (BF) are widely established, and increased exclusivity and a longer duration are associated with numerous positive short- and long-term infant and maternal health outcomes. A primary obstacle to EBF in the U.S. is the lack of access to education and support that promotes BF, explains its numerous health benefits, and provides timely assistance in the postpartum period. Therefore, adapting and scaling up innovative evidence-based interventions that expand access to BF education and support has great potential to improve BF exclusivity, reduce subgroup differences in BF outcomes, and reduce infant and maternal morbidity and mortality. The Lactation Advice Through Texting Can Help (LATCH) intervention is an evidence-based two-way text messaging intervention, developed by our research group. Our feasibility trial findings established that LATCH is feasible, improves time-to-first-contact, and improves EBF rates among the high-intensity users in a controlled research setting, compared to low-intensity users. However, that trial did not provide BF support during non-business hours. Research from other fields strongly supports the use of off-hours care models to improve patient experiences and outcomes. We employed a stakeholder-engaged, user-centered intervention adaptation process to design LATCH with enhanced PC services during non-business hours (hereafter, off-hours or LATCH-OH). Our current objective is to evaluate the comparative effectiveness, implementation, and cost-effectiveness of LATCH-OH compared to the PC program standard of care, in collaboration with the Connecticut WIC program. Our central hypothesis is that the enhanced off-hours PC model (LATCH-OH) will improve BF exclusivity to a greater degree than the standard of care. We will conduct a comparative effectiveness randomized control trial. In Aim 1 we will determine whether LATCH-OH improves EBF compared to the PC program standard of care. Feasibility and acceptability will be measured using a convergent mixed method design, combining periodic user surveys with qualitative data (Aim 2). We will collect resource utilization data and will evaluate the cost effectiveness of LATCH-OH compared to the PC program standard of care (Aim 3). By the end of the project period, we will deliver the implementation, evaluation, and monitoring protocols incorporating the results of the comparative effectiveness trial, cost analysis, and implementation experience. Results will be used by the Connecticut Department of Public Health to scale-up and evaluate the LATCH-OH intervention under real world conditions. The results can inform other states’ efforts to adopt and adapt LATCH-OH to improve BF exclusivity and reduce BF differences among WIC infants nationally.