A review of digital health interventions to support breastfeeding in low- and middle-income countries

Aim: To describe research on digital health interventions designed to support breastfeeding in low- and middle-income countries (LMICs).

Design: Literature review.

Methods: Pre-specified searches were conducted in three databases. Included studies were assessed using the mHealth Evidence Reporting and Assessment (mERA) checklist to evaluate the quality and completeness of reporting (total score 0-16). Critical appraisal was conducted following the Quality Assessment Tool for Diverse Studies (QuADS, percentage of criteria met from total score 0-39). Extracted data were synthesised based on country, primary concept, methodology, demographics, main findings, and intervention type.

Data Sources: Medline, CINAHL, and ProQuest (January 1989 to January 2024).

Results: Twenty-nine studies were included that described digital health interventions for breastfeeding support in LMICs. Digital interventions included one or more of: websites and mobile apps (14 studies), text messages (9 studies) and postnatal telehealth follow-up and education by mobile phone (8 studies). These interventions were designed to support breastfeeding initiation and continuation rates by providing timely information, support, and reminders. Challenges included high attrition rates, limited access to technology and inadequate integration with existing health systems. Quality and completeness of intervention reporting was variable according to the mERA (median = 11 range: 8-15). Methodological and reporting quality was generally high according to the QuADS (median 97%, range 79-100%).

Conclusion: While digital health interventions show promise for breastfeeding support in LMICs, challenges such as technology access disparities, limited health system integration, and inconsistent reporting standards remain. Future research should explore cost-effectiveness, contextual adaptability, and user experience to enhance intervention scalability. The mERA checklist offers a useful framework for reporting digital health interventions, supporting replicability and sustainability.