Breastfeeding challenges, such as pain and perception of insufficient milk supply, prevent many women from exclusively breastfeeding their babies for the six-month duration recommended by the World Health Organization. Mobile health strategies may help women identify and overcome breastfeeding challenges. This study evaluated a two-way short message service (SMS) intervention that delivered breastfeeding messages to women in Kiambu County, Kenya, and its impact on rates of exclusive breastfeeding and breastfeeding behavior at 1, 4, and 6 months post-delivery. Women in the control group received a general package of messages containing postnatal information; women in the intervention group received these messages, plus messages related to breastfeeding and surveys which offered more information about breastfeeding challenges. Both groups of women had access to a help desk agent who responded to questions via SMS.

There was no significant difference in the rate of exclusive breastfeeding between the intervention and control at any time point (p=.861). Women in the intervention group were more likely to report experiencing breastfeeding challenges such as pain and perceived insufficient milk supply than those in the control group (32% vs. 24%, p=0.00). Of the women in the intervention group who reported experiencing breastfeeding challenges, 70% of them found a resolution to their challenge, and 23% of them resolved their challenges using SMS. SMS may help women in low-resource settings to identify and overcome their breastfeeding challenges.

Study follow-up took place over a five month period. An external firm was contracted to collect data via phone surveys conducted by trained female enumerators. Participants were allocated into mutually exclusive follow-up groups to be called at either one, four, or six months after receiving the first postpartum text message, respectively. The questionnaire was designed and initially pretested with a few PROMPTS users, and the final tool was piloted with 10 participants before data collection began. Organizational Network Analysis (ONA) Surveys was used to host the survey and enumerators captured data using the Open Data Kit application on their smartphones (getodk.org, 2020; ONA Systems Inc., 2010). The survey took approximately 15-20 minutes, beginning with obtaining informed consent. It included questions on breastfeeding and infant feeding practices, challenges such as pain while breastfeeding and perceived low milk supply, and demographic questions. The enumerators made up to three over multiple days attempts to reach the participants and participants were considered eligible for follow-up within a window of 14 days of their designated follow-up date. The enumerators were blinded to whether the participants were in the intervention or control groups throughout the data collection process. Study participants could not be blinded to their treatment status because the messages they received either featured breastfeeding information or not. Survey questions were translated into Swahili and participants were asked to select their language of choice during the interview.

The data are in a .txt file. There is a data dictionary in an .xlsx file. The questionnaire that was used for data collection is also included as a .doc file.