Multi-modal Intervention for Lactation Care (MILC) will be a mHealth platform to increase

PROJECT SUMMARY/ABSTRACT The 2017 Centers for Disease Control and Prevention’s (CDC) Breastfeeding Report Card reported that despite a high breastfeeding (BF) initiation of approximately 80% among the Hispanic population in the United States (US), less than 25% of infants were exclusively breastfed (EBF) through 6 months, further perpetuating ethnic disparities in chronic diseases such as diabetes, obesity, and hypertension. Hispanic women are more likely to supplement feeding with formula, than non-Hispanic or African American (AA) mothers. Research has reported that barriers such as insufficient BF education, lack of BF technical support (i.e. latching issues, sore nipples), returning to work, easy access to free or discounted formula milk from Women Infants and Children (WIC), lack of social support, perceived inconvenience, cultural belief that both formula and breastmilk (los- dos) is best for the babies, perception that the infant is not satiated, and embarrassment associated with breastfeeding result in premature weaning off BF among low-income Hispanic mothers. Therefore, increasing the duration of EBF and continuous BF among low-income Hispanic women would require an innovative and comprehensive approach that addresses the diverse range of barriers listed above. The proposed Fast-track proposal titled Multi-modal Intervention for Lactation Care (MILC) will be a mHealth platform that consists of the following innovative components: 1) Chat bot system to provide virtual peer counselor support; 2) Use of escalating magnitude of incentives contingent on remotely observed breastfeeding; 3) Asynchronous and synchronous communication tools to facilitate lactation and social support; and 4) Virtual peer mother to mother support network. We propose the following aims for the Phase I: 1) Conduct formative research with a) low-income Hispanic mothers, b) Certified and international board- certified lactation consultants (CLCs/IBCLCs) and c) in-depth Interviews (IDI)s with WIC staffs/primary care providers (PCPs). 2) Conduct pilot testing of MILC prototype with 20 low-income Hispanic BF mothers who delivered their babies at TUH and 5 CLC/IBCLCs working at TUH to demonstrate feasibility (usability and acceptance). We propose the following aims for the Phase II: 1) Modify Phase I MILC prototype for commercialization and; 2) Conduct a randomized control trial (RCT) with 178 participants from TUH and Christiana Care Health System (CCHS) and 20 CLCs/IBCLCs on MILC to assess MILC’s efficacy to significantly improve EBF rates at 6 months including increasing rates of any BF at month 1, month 3 and month 6. In the long term, the impact of MILC will increase the rates of EBF up to 6 months along with increasing rates of any BF up to 12 months.PROJECT NARRATIVE The innovative platform MILC is designed to provide an integrated and comprehensive professional and social support network with personalized breastfeeding (BF) education to target exclusive breastfeeding (EBF) and any BF behaviors in low-income Hispanic women. Formative research conducted for the development of MILC and results from pilot testing will help guide completion of the development and testing of this prototype that specifically caters to Hispanic women. In the long-term, MILC has the potential to increase the rates of EBF and any BF up to 12 months.