Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Partner-Level Intervention Technology-Based Support

Intervention Description: One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals have been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. Couples allocated to the eHealth study condition (SC1) were provided with access to a previously created, publicly available eHealth breastfeeding co-parenting website, which they could access independently throughout the perinatal period. Couples allocated to the Available Resources Only condition were informed that they could assess breastfeeding resources generally available in the community. Among couples randomized to the SC1, information was collected regarding participation in the virtual meeting and use of the eHealth resource which was assessed at all follow-up time points.

Intervention Results: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% ‘exclusive’ 6 months) and (SC1 71% and SC2 78% ‘any’ 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly.

Conclusion: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

Study Design: RCT

Setting: Online

Population of Focus: Expectant women planning to breastfeed for the first time and their co-parents

Sample Size: 113 expectant women and 104 of their co-parents

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Technology-Based Support

Intervention Description: In the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.

Intervention Results: PCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.

Conclusion: PCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

Study Design: Pre-post study

Setting: Health centers in underserved areas of California and Florida

Population of Focus: Primary care providers (PCPs) who were recruited from federally qualifying health centers and community health centers in underserved areas of California and Florida. The participants included physicians and advanced practice providers, with a focus on those who were responsible for managing diabetes care in these settings

Sample Size: 116 providers

Age Range: Adult providers serving pediatric populations

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention in this study includes the focus of the study is on utilizing electronic health records (EHR) data to develop a machine learning model for predicting the risk of postpartum depression (PPD) in women following childbirth. The study primarily revolves around the development and validation of the machine learning model using EHR data from primary care sources. The strategy described in the study aligns with a data-driven approach, where the researchers analyze EHR data to identify predictors of PPD and develop a predictive model.

Intervention Results: The prevalence of postpartum depression (PPD) in the analyzed cohort was found to be 13.4% . Combining EHR-based prediction with the Edinburgh Postnatal Depression Scale (EPDS) score increased the area under the receiver operator characteristics curve (AUC) from 0.805 to 0.844 and the sensitivity from 0.72 to 0.76, at a specificity of 0.80. The AUC of the EHR-based prediction model alone varied from 0.72 to 0.74 and decreased by only 0.01–0.02 when applied as early as before the beginning of pregnancy.

Conclusion: PPD risk prediction using EHR data may provide a complementary quantitative and objective tool for PPD screening, allowing earlier (pre-pregnancy) and more accurate identification of women at risk, timely interventions and potentially improved outcomes for the mother and child.

Study Design: The study "Estimation of postpartum depression risk from electronic health records using machine learning" is a retrospective cohort study that analyzed electronic health records (EHR) data of 266,544 women from the UK who gave first live birth between 2000 and 2017 . The study utilized a machine learning model to predict the risk of postpartum depression (PPD) during the year following childbirth, based on a multitude of socio-demographic and medical variables extracted from the EHR data . The study also evaluated the performance of the predictive model using multiple validation methodologies, including geographical validation, temporal validation, and random split (pooled 3-fold cross-validation) . The study design is observational, as it analyzed existing data and did not involve any intervention or manipulation of variables

Setting: The study "Estimation of postpartum depression risk from electronic health records using machine learning" was conducted using primary care electronic health records (EHR) data from the UK . The dataset utilized in the study contained records of over 18 million patients, covering approximately 5% of the UK population and was representative of the population in terms of demographics and major condition prevalence . Therefore, the setting for the study was based on the analysis of EHR data from a large cohort of patients within the primary care setting in the UK.

Population of Focus: The study "Estimation of postpartum depression risk from electronic health records using machine learning" is likely to be of interest to a diverse audience, including but not limited to: 1. Healthcare Professionals: The findings of the study, which involve the use of machine learning algorithms to predict the risk of postpartum depression (PPD) using primary care electronic health records (EHR) data, may be relevant to healthcare professionals, particularly those involved in women's health, obstetrics, and mental health care. 2. Researchers and Academics: The study's methodology, use of machine learning, and analysis of a large cohort of patients may be of interest to researchers and academics in the fields of public health, epidemiology, data science, and machine learning applied to healthcare. 3. Public Health Practitioners: The study's focus on early prediction of PPD and the potential value of EHR-based prediction in improving the accuracy of PPD screening may be relevant to public health practitioners involved in maternal and child health programs. 4. Policy Makers and Health Organizations: The study's findings on utilizing EHR data for early prediction of PPD and the potential implications for improving outcomes for mothers and children may be of interest to policy makers and health organizations involved in women's health and mental health policy. 5. Technology and Data Science Professionals: The use of machine learning algorithms and EHR data in predicting PPD risk may be of interest to professionals in the fields of data science, artificial intelligence, and healthcare technology. Overall, the study's findings and methodology have implications for various stakeholders involved in maternal health, mental health, data science, and healthcare delivery.

Sample Size: The study "Estimation of postpartum depression risk from electronic health records using machine learning" analyzed electronic health records (EHR) data of 266,544 women from the UK who gave first live birth between 2000 and 2017 . Therefore, the sample size of the study's cohort is 266,544. This large sample size reflects the extensive data available in the EHR database and allows for a robust analysis of the risk of postpartum depression (PPD) based on a multitude of socio-demographic and medical variables.

Age Range: The study "Estimation of postpartum depression risk from electronic health records using machine learning" focused on women between the ages of 18 and 45 who had their first live birth between 2000 and 2017 . Therefore, the age group included in the study's cohort ranges from 18 to 45 years old. This age range reflects the specific demographic of women who were the subject of the analysis regarding the risk of postpartum depression (PPD) based on electronic health records (EHR) data.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention focuses on using machine learning methods to accurately predict postpartum depression, which can ultimately lead to better preventive interventions and care. The study does not analyze a multicomponent intervention, but rather focuses on identifying predictive factors for postpartum depression using a large dataset and various machine learning algorithms. The study does not describe a specific strategy for intervention, but rather highlights the potential of machine learning methods in improving the identification of high-risk women for postpartum depression.

Intervention Results: The study found that machine learning methods can accurately predict postpartum depression, especially among women without previous mental health issues. The extremely randomized trees method provided the most robust performance with an accuracy of 73%, sensitivity of 72%, and specificity of 75%. The variables that were found to set women at most risk for postpartum depression were depression and anxiety during pregnancy, as well as variables related to resilience and personality. The study suggests that future clinical models could consider including these variables to identify women at high risk for postpartum depression and facilitate individualized follow-up and cost-effectiveness.

Conclusion: Future clinical models that could be implemented directly after delivery might consider including these variables in order to identify women at high risk for postpartum depression to facilitate individualized follow-up and cost-effectiveness.

Study Design: The study utilized a population-based prospective cohort design, drawing data from the BASIC study conducted in Uppsala, Sweden, between 2009 and 2018. The cohort consisted of 4313 participants, and sub-analyses were performed among women without previous depression. The study leveraged clinical, demographic, and psychometric data to assess the accuracy of machine learning methods in predicting postpartum depression. The large sample size allowed for the training of a robust range of different machine learning algorithms, and the dataset included a wide array of background, medical history, pregnancy, and delivery-related variables, as well as psychometric questionnaires. The study design enabled the investigation of the predictive power of these variables and their potential application in identifying women at high risk for postpartum depression.

Setting: The study was conducted using data from the "Biology, Affect, Stress, Imaging and Cognition during Pregnancy and the Puerperium" (BASIC) study, which is a population-based prospective cohort study at the Department of Obstetrics and Gynaecology at Uppsala University Hospital, Uppsala, Sweden. Therefore, the study setting is in Uppsala, Sweden.

Population of Focus: The target audience for this study includes healthcare professionals, researchers in the fields of obstetrics, gynecology, and mental health, as well as professionals and policymakers involved in maternal and child health. Additionally, the findings may be of interest to those working in public health and healthcare administration, particularly in the context of developing interventions and strategies for identifying and supporting women at risk for postpartum depression.

Sample Size: The study included a total of 4313 participants from the BASIC study conducted in Uppsala, Sweden. This large sample size allowed for robust analyses and the evaluation of machine learning methods for predicting postpartum depression.

Age Range: The study did not explicitly mention the age group of the participants. However, the study reported that the mean age for both groups (women with and without depressive symptoms at 6 weeks postpartum) was 31 years. Therefore, it can be inferred that the study participants were likely women in their early thirties.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: To evaluate whether a postpartum text message–based communication platform improves breastfeeding rates.

Intervention Results: From January 2020 to January 2021, 300 patients were enrolled and 216 were randomized as follows: 110 to control and 106 to intervention. In the cohort, 52.8% were Black, 45.4% had public insurance, and 46.3% were nulliparous. There were no differences in demographic, delivery, or postpartum characteristics between groups. Among the 185 patients (85.6%) with data available for the primary outcome, there was no difference in breastfeeding exclusivity by treatment group (intervention 48.4% vs usual care 41.3%, P=.33). When stratified by race, Black patients in the intervention arm had 2.6 times higher odds of exclusively breastfeeding at 6 weeks postpartum compared with Black patients in the control arm (39.5% vs 20.0%, odds ratio 2.62, 95% CI 1.04–6.59). Enrollment in the intervention arm decreased the Black–non-Black disparity in the primary outcome (20.0% vs 66.7%, P<.001in usual care arm vs 39.5% vs 56.0%, P=.11 in intervention arm). There were no differences in other secondary outcomes.

Conclusion: A text message–based communication platform was not associated with breastfeeding exclusivity at 6 weeks postpartum compared with usual care.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: This study investigates the experiences of women using a social media Facebook group for breastfeeding support and attempts to explore whether it has aided in extended breastfeeding success. In addition, it aims to explore the value of social cognitive theory (SCT) in explaining these experiences. Qualitativ, audio-recorded, semi-structured interviews were conducted from eight women who were members of a private Facebook group.

Intervention Results: A number of themes were identified from the women's experiences, with analysis uncovering the superordinate theme 'increased self-efficacy' which provided an understanding of how the group impacted women's experiences and aided them in breastfeeding success. The sub-themes of education, accessibility, online community, normalization, and extended goals provided a more detailed understanding of how self-efficacy was increased through group membership.

Conclusion: The symbiotic relationship between members of a social media group facilitates greater breastfeeding success and a longer duration of breastfeeding through the central concept of the SCT: reciprocal determinism. Therefore, it is posited that the SCT is a suitable theory of behaviour change which can potentially be used to develop interventions aiming to increase breastfeeding rates and duration.

Study Design: Qualitative study (exploratory, deductive approach)

Setting: Social media platform: Private Facebook group

Population of Focus: Women who were members of a private Facebook group

Sample Size: 8 women

Intervention Components (click on component to see a list of all articles that use that intervention): Telelactation Technology-Based Support Telephone Support PATIENT_CONSUMER

Intervention Description: To identify facilitators and barriers of two modes of tele-health service utilization and to compare the differences between two modes of providing tele-lactation services on breastfeeding knowledge, breastfeeding intention, perceived social support, and 3-month breastfeeding continuation behavior.

Intervention Results: No significant difference in demographic characteristics across groups was found. At 3 months after discharge, both groups reported continued breastfeeding (telephone-only: n = 17, 81%; audio-visual: n = 18, 90%) with no significant difference between the two groups (p = .663). Additionally, no group differences were found for breastfeeding knowledge or perceived social support. Overall, participants reported positive experiences with tele-lactation, emphasizing the convenience, accessibility, education, and support provided.

Conclusion: We found that both telephone-only and audio-visual delivery of tele-lactation services were equally effective. Both methods of tele-lactation services should be considered by health care providers to encourage and sustain breastfeeding behavior in mothers.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Educational Material PATIENT_CONSUMER

Intervention Description: 1) Determine if using the Mother’s Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app.

Intervention Results: There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study.

Conclusion: MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network--Facebook. A randomized clinical trial was performed involving 251 mother–child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age.

Intervention Results: The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001).

Conclusion: This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.

Study Design: Single-blind, RCT

Setting: Social media platform: Facebook

Population of Focus: Mother-child pairings assisted in the maternity ward of a Baby-Friendly Hospital who used Facebook

Sample Size: 251 mother-child pairings

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Telephone Support Technology-Based Support COMMUNITY Individual Supports

Intervention Description: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users.

Intervention Results: A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays.

Conclusion: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care.

Study Design: Observational study using surveys and electronic medical records

Setting: Providence St. Joseph Health's Consumer Innovation Team launched app in Portland, Oregon and greater Seattle, Washington areas/Online

Population of Focus: Women with four or more prenatal encounters at one of the seven selected clinics that gave birth to a live infant at a Providence hospital in the past 4-6 months

Sample Size: 567 women (167 in the app user group and 400 in the comparison nonuser group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Training (Parent/Family) EMR Reminder Technology-Based Support

Intervention Description: The intervention described in the document aligns with a discernible strategy. The specific intervention involved a comprehensive educational in-service for the providers at the clinic, which included an overview of the significance of postpartum depression (PPD), the consequences associated with PPD among women and their children, instruction and directions regarding how to use the Edinburgh Postnatal Depression Scale (EPDS) screening tool, and how to document PPD screening in the electronic health record (EHR) system . This intervention aligns with a strategy of education and training to improve providers' knowledge and skills in PPD screening and documentation. Additionally, the implementation of the EPDS dialog box with a flag in the EHR system was part of the intervention, which aimed to facilitate standardized screening and documentation practices . This aligns with a strategy of integrating technology and standardized tools into clinical practice to improve screening and documentation processes. The study described in the document does analyze a multicomponent intervention. The intervention included multiple components such as the educational in-service, development of the EPDS dialog box in the EHR system, and provider follow-up. The study involved pre- and post-education questionnaire results, electronic health record chart reviews, and data analysis to assess the impact of the multicomponent intervention on PPD screening practices.

Intervention Results: The study found that PPD screening documentation rates increased from 56% to 92.7% after the intervention, indicating a significant improvement in PPD screening rates. Of the 124 electronic health record (EHR) charts audited after the project intervention, 115 charts had documentation of EPDS screening, demonstrating a substantial increase in provider-documented screening rates with the implementation of the EPDS tool . The data analysis showed a significant improvement in PPD screening rates from 56% before the project to 92.7% after the project intervention . The project outcomes identified greatly improved provider self-reported knowledge of the Affordable Care Act (ACA) preventive PPD perinatal care services . These results indicate that the multicomponent intervention, including education, training, and the implementation of the EPDS tool in the EHR system, had a significant positive impact on PPD screening practices among providers in the community women's health care clinic.

Conclusion: PPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women’s health care clinic.

Study Design: The study design/type used in the project to improve postpartum depression (PPD) screening practices among providers in the community women's health care clinic is a quasi-experimental study. The study used a pre- and post-intervention design to evaluate the impact of the multicomponent intervention on PPD screening practices and providers' knowledge in the community women's health care clinic. The study involved pre- and post-education questionnaire results, electronic health record chart reviews, and data analysis to assess the impact of the intervention on PPD screening practices , . However, the study did not include a control group, which is a characteristic of a true experimental study design. Therefore, the study design/type used in this project is a quasi-experimental study.

Setting: The setting for the study was a local community women's health care clinic located in the southwestern United States. The clinic primarily served minority women of lower socioeconomic status, including Hispanic and African American women, and those who were uninsured. The clinic provided care for postpartum women and was the focus of the project to improve postpartum depression (PPD) screening practices among healthcare providers. The clinic also served as a teaching setting for obstetrician-gynecologists, family practice medical residents, medical students, and nurse practitioner students. The average birth rates per physician in the clinic ranged from 40 to 45 births per month

Population of Focus: The target audience for the study is healthcare providers, specifically obstetrician-gynecologists and advanced practice registered nurses, who provide care to postpartum women in a community women's health care clinic. The study aimed to improve the PPD screening practices among healthcare providers in the clinic by implementing a standardized screening tool and providing education and training on preventive PPD screening practices and documentation recommendations . The study's findings and recommendations are relevant to healthcare providers who care for postpartum women and can be applied in various healthcare settings to improve PPD screening practices and outcomes. Additionally, the study's findings may be of interest to healthcare administrators, policymakers, and researchers who are interested in improving maternal mental health outcomes and reducing the burden of PPD.

Sample Size: The project involved the audit of 125 electronic health record (EHR) charts to assess the pre-intervention PPD screening rates . Additionally, after the project intervention, data were collected from 124 EHR charts over a 3-month period to evaluate the impact of the intervention on PPD screening practices . Therefore, the sample size for the EHR chart audits was 125 before the intervention and 124 after the intervention.

Age Range: The age range of the study was not explicitly mentioned in the provided document. Therefore, I cannot provide specific information regarding the age range of the participants in this study. If you have access to the original document, I would recommend checking the full text for any additional details on the age range of the participants.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Technology-Based Support

Intervention Description: The intervention involved an educational intervention for providers and the integration of an MI-based communication tool called MOTIVE (MOtivational Interviewing Tool to Improve Vaccine AcceptancE)

Intervention Results: Statistically significant differences were observed between the groups for age and ethnicity, with a larger proportion of younger age groups and more patients of Hispanic/Latino ethnicity in the intervention period

Conclusion: Use of an MI-based communication tool may decrease vaccine refusals and improve childhood vaccination coverage rates, particularly for IIV.

Study Design: The study utilized a pre-post intervention design, with data collected retrospectively from the electronic health record (EHR) during two time periods: a baseline period and an intervention perio

Setting: the Rocking Horse Community Health Center (RHCHC) in the United States

Population of Focus: Children aged 0–6 years and their parents or guardians

Sample Size: A total of 2504 patients were included in the baseline period, and 1954 patients were included in the intervention period

Age Range: Children aged 0–6 years

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material Technology-Based Support Telephone Support PATIENT_CONSUMER

Intervention Description: This study was conducted to determine the effect of tele-education offered to mothers during the COVID-19 pandemic on breastfeeding success and perceived breastfeeding self-efficacy.

Intervention Results: It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Conclusion: The researchers provided a 4-week long education and counseling service to mothers in the experimental group via direct phone calls and text messages. It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Supports Social Media

Intervention Description: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates.

Intervention Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages.

Conclusion: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool.

Study Design: Process evaluation

Setting: Social media platform: Facebook

Population of Focus: Pregnant African American women recruited through WIC

Sample Size: 472 women

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention involved the use of an iPad-based baseline survey to collect information about participants' attitudes and beliefs about HPV infection and vaccination, demographics, and self-reported vaccination status. Participants were then provided with either tailored information (CHICOS intervention) or untailored information about HPV vaccination. The tailored intervention was individually customized based on the collected survey data, while the untailored intervention provided information from the CDC's HPV Vaccine Information Sheet

Intervention Results: The study found low levels of vaccination (2%-6%) in the young adult population, despite high vaccination intentions, suggesting significant and systematic barriers that could not be overcome by the information provided in the interventions. Lack of insurance coverage was identified as a contributing factor to low vaccination rates among the study population. The study found that the tailored intervention (CHICOS) did not lead to significant increases in HPV vaccine utilization compared to an untailored intervention or usual care, for both adolescents and young adults . The results indicated that there were essentially no differences between the CHICOS and untailored arms in any vaccination measure, or between the untailored or CHICOS arms and usual care . Therefore, based on the findings of the study, the tailored intervention did not increase HPV vaccine uptake among the targeted population.

Conclusion: The study highlighted the challenges in increasing HPV vaccination rates among young adults, particularly those without insurance coverage. It also emphasized the need for interventions to address systematic barriers to vaccination uptake

Study Design: The study utilized a randomized controlled trial design with participants assigned to one of three study arms in a 1:1:1 ratio

Setting: The study took place in the waiting rooms of 5 primary care clinics in central Colorado that serve low-income, primarily Latino, medically underserved clientele and were all part of a single health system

Population of Focus: The target audience included parents of children aged 9-17 years and young adults aged 18-26 years who were patients of the clinic and could read and converse in English or Spanish

Sample Size: The study aimed to have at least 573 parents and 426 young adults participating in the study to detect a 15% or greater difference in HPV vaccination use between any 2 arms

Age Range: The age range of the participants included parents of children aged 9-17 years and young adults aged 18-26 years

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated.

Intervention Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times.

Conclusion: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Online Material/Education/Blogging

Intervention Description: The specific intervention in the study is the use of the ClinTouch DAWN-P smartphone app for postnatal depression screening. The intervention involves participants using the app from ≥ 36 weeks gestation until 6 weeks postpartum. The app is used for daily assessments, and the study aims to assess the feasibility, safety, usability, and acceptability of using the app for postnatal depression screening. The intervention aligns with a discernible strategy of utilizing technology (smartphone app) to facilitate postnatal depression screening and monitoring. It is not explicitly described as a multicomponent intervention, as the focus appears to be on the use of the smartphone app for screening and data collection.

Intervention Results: The study found the following results: 1. Feasibility: Most eligible pregnant women approached were keen to participate in the study, and the majority of participants continued to use the app for the full study period. The average completion rate of daily app-based assessments was 67% . 2. Usability and Acceptability: Participants found the app easy to use, and the qualitative interviews revealed suggestions for modifications to improve usability, such as summarizing the user's EPDS responses, linking them to information and support, and adding general parenting content . 3. Validity: The app-based responses showed high agreement with standard EPDS, and both app-based and paper-based ratings showed perfect agreement in identifying cases of likely postnatal depression . 4. Engagement Patterns: Participant age was significantly correlated with the percentage of app completion, with older participants completing more daily assessments. Participants with a history of depression or previous prescription of psychiatric medication completed a lower percentage of app assessments . 5. Safety: There were no serious adverse events relating to app use . Overall, the study found the digital solution to be feasible, safe, acceptable, and valid for postnatal depression screening, and it was also beneficial for remote delivery, as all participants were enrolled remotely during the first COVID-19 lockdown

Conclusion: Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers.

Study Design: The study design is a proof-of-concept feasibility study, which is a type of pilot study that aims to assess the feasibility of a larger study by testing the study procedures, interventions, and outcome measures. The study used a mixed-methods approach, combining quantitative and qualitative data collection and analysis.

Setting: The study site was St Mary’s Hospital, a large maternity hospital operating across Greater Manchester, UK.

Population of Focus: The target audience for the study is healthcare professionals, researchers, and policymakers interested in improving access to postnatal depression treatment and supporting parents during the postnatal period.

Sample Size: The sample size for the study consisted of 15 mothers and 8 partners, totaling 23 participants who completed the study

Age Range: The age group of the participants is not explicitly mentioned in the provided excerpts. Therefore, I cannot provide specific information about the age group of the participants in the study

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages).

Intervention Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study.

Conclusion: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life.

Intervention Components (click on component to see a list of all articles that use that intervention): Telehealth Technology-Based Support

Intervention Description: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. To inform future practice and policies, we sought to characterize PCPs' recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over.

Intervention Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001).

Conclusion: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends.

Study Design: Cross-sectional survey

Setting: Pediatric primary care practices across the US

Population of Focus: Primary care providers including physicians, advanced practitioners (ie, nurse practitioners and physician assistants), and nurses who provided primary care, including vaccinations, to adolescents aged 11-17 years

Sample Size: 1047 respondents comprised of physicians (n=747, 71%), advanced practitioners (n=177, 17%), and nurses (n=123, 12%)

Age Range: Primary care providers serving youth ages 11-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Telephone Support Technology-Based Support COMMUNITY Individual Supports

Intervention Description: We assessed whether increased use of breastfeeding smartphone applications (apps) impacts breastfeeding rates for low-income women. Women were randomized to one of two novel apps: control app containing digital breastfeeding handouts and BreastFeeding Friend (BFF), an interactive app containing on-demand breastfeeding educational and video content. The BFF app was a novel smartphone app designed based on a cross-sectional breastfeeding survey and feeback from focus group of postpartum, low-income African American women. Specifically, a multidisciplinary team of lactation consultants, perinatologists, and neonatologists designed the BFF app. The educational content included interactive advice on overcoming breastfeeding challenges, educational content on breastfeeding benefits, normal infant behavior and maternal postpartum physiology, strategies to optimize breastfeeding and pumping at work or school, hyperlinks to on-demand videos with tips and troubleshooting for successful latching, common breastfeeding positions, and using and cleaning a breast pump, as well as links to resources. All participants were given a complimentary Android smartphone with assigned breastfeeding app preloaded by a telecom provider.

Intervention Results: In the RCT, BFF and control app median uses were 15 (interquartile range [IQR] 4–24) and 9 (IQR 5–19) (p = 0.1), respectively. Breastfeeding initiation did not differ with app usage (84.1% in highest quartile versus 78.2% for lowest quartile; p = 0.5). Rates of sustained and exclusive breastfeeding through 6 months were similar between groups. Among both groups, smartphone apps were the most preferred breastfeeding resource at 6 weeks. Low quartile users also preferred alternative online breastfeeding resources: >50% of all users preferred technology-based breastfeeding resources.

Conclusion: Increased usage of breastfeeding apps did not improve breastfeeding rates among low-income women. However, technology-based resources were the most preferred breastfeeding resource after hospital discharge, indicating ongoing development of technology-based interventions has potential to increase breastfeeding in this high-needs population. clinicaltrials.gov (NCT03167073).

Study Design: Secondary analysis of an RCT

Setting: Prenatal clinic serving women with Medicaid or no health insurance at an academic medical center/Online

Population of Focus: Pregnant women at approximately 36 weeks' gestation recruited during routine obstetric appointments

Sample Size: 169 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The study primarily emphasizes the use of remote assessments, such as the Edinburgh Postnatal Depression Scale (EPDS) and mood assessments, to facilitate early identification and differentiation of postpartum depression and adjustment disorder . The strategy appears to align with a proactive approach to screening and monitoring maternal mental health using digital phenotyping and clinical assessments.

Intervention Results: The study identified several factors associated with postpartum depression (PPD) and adjustment disorder (AD), including personal and familial psychiatric history, subjective birth-related psychological traumas, and postpartum blues . Additionally, the study found that a higher prevalence of premenstrual syndrome (PMS) and reduced breastfeeding at a later time point were observed in PPD compared to healthy controls . The study also highlighted the importance of remote assessments in providing insight into the development and interaction of mood, stress, and maternal sensitivity in the first weeks postpartum . Furthermore, the study emphasized the potential of digital phenotyping and remote assessments in facilitating early and accurate identification and differentiation of PPD and AD, which could be easily translated into routine care . Overall, the results of the study contribute to the understanding of factors associated with postpartum depression and adjustment disorder, as well as the potential utility of digital phenotyping and remote assessments in early identification and differentiation of these conditions.

Conclusion: Combinations of in clinic and remote self-assessments allow for early and accurate detection of PPD and AD as early as three weeks postpartum, enabling early intervention to the benefit of both mothers and children.

Study Design: The study design/type is a longitudinal observational study. The research followed two cohorts of mothers giving birth and collected data longitudinally over 12 weeks to explore the feasibility of accurately predicting postpartum depression (PPD) based on socio-demographic and clinical-anamnestic information, as well as early symptom dynamics using remote mood and stress assessments . The study utilized a machine learning approach to identify combinations of demographic and clinical data achieving the highest accuracy for the early identification and differentiation of PPD and AD . The study design involved the collection of detailed sociodemographic-anamnestic and clinical interview data at baseline, followed by remote assessments of mood and stress levels, depression scores, and attachment scores over the 12-week observation period . Additionally, the study included a prospective second cohort to validate the accuracy of the proposed algorithm for early identification and differentiation of PPD and AD .

Setting: he study was conducted in Germany, specifically at the University Hospital Aachen, the Medical Faculty of Heinrich Heine University Düsseldorf, and the RoMed Hospital Rosenheim . The study's setting was a combination of in-clinic and remote assessments, with participants undergoing a detailed sociodemographic-anamnestic and clinical interview at the clinic immediately after childbirth (T0) and a second clinical interview at the clinic 12 weeks postpartum (T4) . Remote assessments were collected over 12 weeks, comprising mood and stress levels, depression scores, and attachment scores, with participants completing online questionnaires on a bi-daily basis . The study's use of both in-clinic and remote assessments allowed for a comprehensive evaluation of the temporal dynamics of postpartum depression and adjustment disorder, providing valuable insights into the early identification and differentiation of these conditions.

Population of Focus: The target audience for the study includes healthcare professionals, researchers, and policymakers involved in maternal and perinatal mental health. Specifically, obstetricians, gynecologists, psychiatrists, psychologists, and other mental health professionals who work with postpartum women may find the study's findings relevant to their clinical practice. Additionally, researchers in the fields of perinatal mental health, epidemiology, and digital health may be interested in the study's methodology and results. Furthermore, policymakers and public health officials involved in developing and implementing maternal mental health programs and interventions may benefit from the study's insights into early identification and differentiation of postpartum depression and adjustment disorder. The study's focus on leveraging demographic, clinical, and digital phenotyping data for predictive modeling and early intervention has implications for public health strategies aimed at improving maternal mental health outcomes. Overall, the study's findings have implications for clinical practice, research, and public health initiatives related to postpartum mental health, making it relevant to a diverse audience involved in maternal and perinatal care.

Sample Size: The study recruited a total of 501 mothers for the two cohorts. The first cohort consisted of 308 mothers, and the second cohort consisted of 193 mothers . The first cohort was used to identify the best predictors of postpartum depression (PPD) using a machine learning approach, while the second cohort was used to validate the accuracy of the proposed algorithm for early identification and differentiation of PPD and adjustment disorder (AD) . The sample size of the study is considered relatively small, but it is typical for longitudinal observational studies that require detailed clinical and demographic data collection and follow-up assessments over an extended period.

Age Range: The study did not specify a specific age group for the participants. However, the study recruited mothers giving birth at the University Hospital Aachen between November 2015 and June 2018 for the first cohort and between November 2018 and January 2020 for the second cohort . The mean age of the first cohort was 31.7 ± 4.76, and the mean age of the second cohort was 32.7 ± 4.78 . Therefore, the study participants were likely to be adult women of reproductive age who had recently given birth.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Telephone Support Peer Counselor Lactation Consultant Technology-Based Support COMMUNITY Individual Supports

Intervention Description: LATCH -- Lactation Advice thru Texting Can Help is a pilot, web-based texting intervention designed to improve breastfeeding rates among mothers receiving WIC. The two-way texting intervention provided both evidence-based breastfeeding education through automated texts adn a mode for mothers to freely exchange texts with breastfeeding peer counselor (PC). In addition to providing breastfeeding education, the automated texts were personalized by addressing the mother by name and signed by the PC. These automatic personalized texts were sent out regularly both prenatally and in the immediate post-partum period to increase peer counselor points of contact with mom via text. The web-based texting platform allowed all text messages to be recorded, and thus, the on-site lactation consultants and WIC supervisors were able to monitor and supervise all text-based communication regularly.

Intervention Results: Primary outcomes included early post-partum (PP) contact and exclusive breastfeeding (EBF) rates at 2 weeks PP. Feasibility outcomes included text messaging engagement and mother's satisfaction with texting platform. Fifty-eight women were enrolled, 52 of whom were available for intention-to-treat analysis (n = 30 texting, n = 22 control). Contact between mothers and PCs within 48 hr of delivery was greater in the texting group (86.6% vs. 27.3%, p < .001). EBF rates at 2 weeks PP among participants in the texting intervention was 50% versus 31.8% in the control arm (p = .197). Intervention group mothers tended to be more likely to meet their breastfeeding goals (p = .06).

Conclusion: Participants were highly satisfied with the Lactation Advice thru Texting Can Help intervention, and findings suggest that it may improve early post-delivery contact and increase EBF rates among mothers enrolled in WIC who receive PC. A large, multicentre trial is feasible and warranted.

Study Design: Pilot RCT

Setting: WIC breastfeeding programs at a hospital-based primary care center and a federally qualified community health center/Cell phone

Population of Focus: Pregnant women at 18-30 weeks gestation from local WIC breastfeeding peer counselor programs

Sample Size: 52 women (30 texting and 22 control)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Patient Reminder/Invitation Text Messaging

Intervention Description: As part of an ongoing quality improvement project, the hospital implemented a remote hypertension monitoring protocol for postpartum women with a diagnosis of chronic hypertension, superimposed preeclampsia, gestational hypertension, preeclampsia, or postpartum hypertension. After identification by an obstetric care provider, women with access to a text messaging-enabled smartphone device are enrolled in the 6-week postpartum program, which is automatically indicated in the electronic medical record. Participants are trained on the use of a blood pressure device (obtained through insurance, patient purchase or hospital provision) by a nurse educator before discharge from the hospital. After discharge, participants are prompted to check their blood pressure 5 days per week and are prescribed an antihypertensive medication from a call center physician if clinically indicated. Women with blood pressures exceeding the goal who are asymptomatic are encouraged to keep their postpartum office visit.

Intervention Results: Among women enrolled in the program, 360 (88%) attended a 6-week postpartum visit, compared with a historical background rate of 60% attendance among all deliveries and 66% attendance among women with a hypertensive disorder of pregnancy in the year before implementation of the program (2017). Compliance with the program was high. Based on the protocol, 177 (43%) women did not require the previously scheduled in-office blood pressure check at 1-week postpartum, the majority (112; 63%) were in the no medication group. Of the 232 women who required a blood pressure check based on the protocol, 198 (85%) women attended the visit. Of the 409 women who have completed the program to date, 340 (83%) continued the program beyond 3 weeks postpartum and 302 (74%) continued the program beyond 4 weeks postpartum. An ongoing goal of the program is to bridge care from obstetricians to primary care physicians; currently 87 (21%) participants have established care with a primary care physician postpartum, with an additional 42% reporting that they have scheduled an appointment with their primary care physician.

Conclusion: In this study, we detail results from an ongoing remote blood pressure monitoring program. We demonstrate high compliance, retention, and patient satisfaction with the program. This is a feasible, scalable remote monitoring program connected to the electronic medical record.

Study Design: Quality improvement project

Setting: University of Pittsburgh medical center

Population of Focus: At risk postpartum women

Sample Size: 499

Age Range: Childbearing age

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Patient Reminder/Invitation Text Messaging

Intervention Description: The intervention involved a text-based surveillance arm, where women were given an automatic Omron blood pressure cuff and instructed on its use. Patients were enrolled into a texting program platform developed through Way to Health, a web-based platform within the institution, with secure technological infrastructure developed for research. Patients received reminders to text message their blood pressures twice daily for 2 weeks postpartum, and immediate feedback was provided to the patient based on a preprogrammed automated algorithm. The primary investigator was alerted with specified severe range blood pressure values via text message or email, and care was escalated as needed based on the outpatient algorithm used in the office

Intervention Results: The study found that text-based monitoring was more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate post-discharge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Conclusion: Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Study Design: Randomized control trial

Setting: Two prenatal practices within a single medical sytem

Population of Focus: Health care providers; postpartum patients with pregnancy-related hypertenion

Sample Size: 206 women with pregnancy-related hypertension

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: To evaluate the impact of mobile phone text messages on breastfeeding practices.

Intervention Results: Exclusive breastfeeding prevalence was significantly higher in the intervention than in the control group for the 6 follow-up visits combined (RR: 1.48; 95%CI: 1.35, 1.63; P < 0.001) and at each monthly follow-up visit. At 6 mo, exclusive breastfeeding was 43.4% in the intervention compared with 15.3% in the control group (RR: 2.74; 95%CI: 1.79, 4.19; P < 0.001). Also, at 6 mo, the intervention increased current breastfeeding (RR: 1.17; 95%CI: 1.07, 1.26; P < 0.001) and reduced bottle feeding (RR: 0.30; 95%CI: 0.17, 0.54; P < 0.001). Exclusive breastfeeding was progressively higher in the intervention group than in the control group at each follow-up (P for interaction < 0.001) and similarly for current breastfeeding. The intervention increased the mean breastfeeding self-efficacy score (adjusted mean difference 4.0; 95%CI: 1.36, 6.64; P = 0.030). Over the 6-month follow-up, the intervention significantly reduced diarrhea risk by 55% (RR: 0.45; 95%CI: 0.24, 0.82; P < 0.009).

Conclusion: Regular, targeted text messages delivered to urban pregnant women and mothers via mobile phones significantly improve breastfeeding practices and reduce infant morbidity during the first 6 mo of life.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention focuses on the development and validation of a machine learning-based prediction model for assessing the risk of developing PPD within a year following delivery. The model uses routinely collected electronic health record (EHR) data to identify women at risk for PPD before the onset of depressive symptoms.

Intervention Results: The study included a nationwide longitudinal cohort of 214,359 births between January 2008 and December 2015. Among this birth cohort, 1.9% (n = 4104) met the case definition of new-onset postpartum depression (PPD) . The prediction model achieved an area under the curve (AUC) of 0.712 in the validation set, with a sensitivity of 0.349 and a specificity of 0.905 at the 90th percentile risk threshold. This indicates that the model was able to identify PPD cases at a rate more than three times higher than the overall set. The positive and negative predictive values were 0.074 and 0.985, respectively . The model's strongest predictors included both well-recognized factors (e.g., past depression) and less-recognized PPD risk factors, such as differing patterns of blood tests . These results demonstrate the potential of machine learning-based models incorporating electronic health record (EHR)-derived predictors to augment symptom-based screening practices by identifying the high-risk population at greatest need for preventive intervention before the development of PPD.

Conclusion: Machine learning-based models incorporating EHR-derived predictors, could augment symptom-based screening practice by identifying the high-risk population at greatest need for preventive intervention, before development of PPD.

Study Design: The study design was a nationwide longitudinal cohort study that utilized electronic health record (EHR) data to develop and validate a machine learning-based postpartum depression (PPD) prediction model. The cohort included 214,359 births between January 2008 and December 2015, which were divided into model training and validation sets . The study used a gradient-boosted decision tree algorithm to analyze EHR-derived sociodemographic, clinical, and obstetric features and identify novel PPD predictors. The model's performance was evaluated using various outcome measures, including the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) . The study design allowed for the development of a PPD prediction model that could stratify postpartum women into distinct risk groups based on routinely collected EHR data. The model's performance was validated using a separate validation set, which supports the generalizability of the findings

Setting: The study was conducted using data from the Clalit Health Services (CHS) electronic health record (EHR) data warehouse. CHS is the largest health maintenance organization in Israel, covering over 4.4 million members, which equates to approximately 53% of the population. The EHR data warehouse includes sociodemographic information, diagnoses from ambulatory services and hospital admissions, drug prescriptions, and laboratory test results. This setting allowed for the construction of a longitudinal nationwide birth cohort for the development of a risk prediction model for postpartum depression (PPD) to be applied at birth. The use of this extensive EHR data from a large and diverse population contributes to the generalizability and real-world applicability of the study's findings and the developed PPD prediction model.

Population of Focus: The target audience for this study is healthcare professionals, researchers, and policymakers interested in postpartum depression (PPD) screening and prevention. The study's findings and the machine learning-based PPD prediction model developed and validated in the study have implications for public health systems and the well-being of postpartum women. The study's focus on utilizing electronic health record (EHR) data and advanced machine learning tools to develop a screening tool for PPD in a nationally representative sample of the general population may also be of interest to professionals in the fields of health informatics and data science.

Sample Size: The study utilized a nationwide longitudinal cohort of 214,359 births between January 2008 and December 2015. This large-scale cohort provided a substantial sample size for the development and validation of the machine learning-based postpartum depression (PPD) prediction model. The cohort was divided into a training set and a validation set for model development and assessment, respectively. The robust sample size of the cohort contributes to the generalizability and reliability of the study's findings and the performance of the PPD prediction model

Age Range: The study did not explicitly mention the specific age range of the participants. However, it focused on a nationwide longitudinal cohort of births between January 2008 and December 2015, which implies that the study population consisted of postpartum women within this timeframe. Therefore, the age range of the participants would likely encompass women of reproductive age who gave birth during this period. For specific details on the age range, it may be necessary to refer to the original study or contact the authors for further information.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination Technology-Based Support

Intervention Description: A social worker coordinated medical care for children in foster care in a foster care medical home (FCMH) and tracked care coordination (CC) activities using a modified Care Coordination Measurement Tool© (mCCMT).

Intervention Results: The CC prevented 11 emergency department (ED) visits, 9 placement disruptions, and 42 patient privacy violations. Children assigned to a FCMH have diverse CC needs and benefit from social workers’ specialized skills.

Conclusion: In summary, the mCCMT findings demonstrated the needs of patients and benefits of social worker CC in enhanced primary care provision in a FCMH. Duplication and customization of this model is a robust option for improving outcomes for pediatric patients in the foster care system. The social worker’s specialization was paramount in ensuring that children in foster care had consistent, continuous, and comprehensive medical care. They made connections to community dental and mental health resources and prevented unnecessary ED visits (and the associated excessive health care costs). Our description of social worker activities specialized for children and youth in foster care offers a model of care for pediatric medical homes, particularly practices where there may be a larger proportion of children involved in the child welfare system. Our findings suggest that a dedicated social worker to oversee FCMH care management is a promising intervention for improving permanency outcomes for children in foster care and supporting the health and resiliency of foster families.

Study Design: The study design was a retrospective observational study. The study used a modified version of the Care Coordination Measurement Tool© (mCCMT) to collect data on care coordination encounters for children in foster care over an eight-month period. The study analyzed the data to describe the characteristics of the children, the care coordination activities provided, and the time spent on care coordination activities.

Setting: The study was conducted in a foster care medical home (FCMH) within a primary care clinic that served nearly 6,000 unique children during the eight-month study period. The FCMH was embedded in an outpatient pediatric and adolescent clinic, and the social worker coordinated medical care for children in foster care within this setting.

Population of Focus: The target audience for the study includes healthcare professionals, social workers, policymakers, and researchers interested in improving care coordination for children and youth in foster care. Additionally, the findings may be relevant to professionals working in pediatric medical homes, particularly those serving a larger proportion of children involved in the child welfare system.

Sample Size: 60 children in foster care

Age Range: The age range of the children included in the study was from 1 day to 18 years. The majority of the children were under the age of 5 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The study is based on an intervention that involved the use of a specific mobile eHealth tablet developed to allow digital communication between parents and health care providers during the family’s transition from hospital to home. The intervention was part of a larger study (ClinicalTrials.gov identifier: NCT04150120) that aimed to evaluate the use of eHealth for self-management in parents caring for their child at home following pediatric surgery or preterm birth. The intervention described in the study aligns with a directed approach introducing aperture, which is an opening or pathway where communication is transmitted in cyberspace, generating concerns due to its less defined nature. The study aimed to explore the dimensions of access to health care as perceived by parents when caring for their child at home, with conventional care supported by eHealth following pediatric surgery or preterm birth. The study analyzed the experiences of parents who utilized eHealth solutions following pediatric surgery or preterm birth, and it sheds light on the dimensions of access to health care from the parental perspective. The study does not analyze a multicomponent intervention, but rather focuses on the use of a specific eHealth solution and its impact on access to health care for parents caring for their child at home.

Intervention Results: The specific results of the study are not provided in the excerpt from the PDF. However, the study aimed to analyze access to health care as perceived by parents when caring for their child at home, with conventional care supported by eHealth following pediatric surgery or preterm birth. The study utilized directed content analysis guided by a framework for dimensions of access, including approachability, acceptability, affordability, appropriateness, and availability . The study also explored the parents' experiences of using the eHealth tablet for communication with health care providers, and it aimed to identify both positive and negative aspects of eHealth in the context of pediatric care at home. The findings of the study would provide insights into how eHealth solutions impact the perceived access to health care for parents caring for their child at home, and may offer implications for the future of pediatric care and eHealth implementation . For specific results and detailed findings of the study, it would be necessary to access the full text of the research article.

Conclusion: The study aimed to shed light on the dimensions of access to health care as perceived by parents when caring for their child at home, with conventional care supported by eHealth following pediatric surgery or preterm birth. The study utilized directed content analysis guided by a framework for dimensions of access, including approachability, acceptability, affordability, appropriateness, and availability . The study also explored the parents' experiences of using the eHealth tablet for communication with health care providers, and it aimed to identify both positive and negative aspects of eHealth in the context of pediatric care at home. The findings of the study would provide insights into how eHealth solutions impact the perceived access to health care for parents caring for their child at home, and may offer implications for the future of pediatric care and eHealth implementation .

Study Design: This is a qualitative research design. Specifically, it involved parental interviews as part of an intervention study (ClinicalTrials.gov identifier: NCT04150120) that aimed to evaluate the use of eHealth for self-management in parents caring for their child at home following pediatric surgery or preterm birth . The qualitative research approach allowed the researchers to gain insights into the dimensions of access to health care as perceived by parents, with a focus on their experiences and perceptions of utilizing eHealth solutions in the context of pediatric care at home. Directed content analysis was used to analyze the interviews, guided by a framework for dimensions of access, including approachability, acceptability, affordability, appropriateness, and availability . The study design aimed to provide a deeper understanding of the experiences and perspectives of parents utilizing eHealth solutions, and the findings may offer valuable insights for healthcare providers, hospital management, and those involved in the development and implementation of eHealth solutions for pediatric care at home

Setting: The study described in the provided PDF was conducted at a university hospital in the south of Sweden. The children involved in the study were cared for at the neonatal and pediatric surgery departments at this hospital. The neonatal department has approximately 400 admissions each year and covers a catchment area of 500,000 residents who live within 80 km. The department of pediatric surgery is a national specialized center for specific malformations such as Hirschsprung’s disease, anorectal malformations, and esophageal atresia, and is a tertiary center for other specialized pediatric surgery. At the department, 1200 operations are performed annually, including 150 advanced malformation procedures in neonates. It covers a catchment area of 5 million residents living within 600 km . The families were included consecutively at each department after accepting an invitation to participate in the study. The inclusion criteria were parents or legal guardians who could read and write Swedish or English and had children under four years of age who were planned for discharge after advanced hospital treatment for prematurity or surgery for congenital colorectal malformations such as reconstruction of anorectal malformations and Hirschsprung’s disease .

Population of Focus: The target audience for the study described in the provided PDF includes healthcare professionals, hospital management, policymakers, and researchers involved in pediatric care, eHealth implementation, and improving access to healthcare for parents caring for their children at home. The study aimed to provide insights into the dimensions of access to health care as perceived by parents when caring for their child at home, with conventional care supported by eHealth following pediatric surgery or preterm birth . The findings of the study may be valuable for healthcare providers and hospital management in understanding the experiences and perspectives of parents utilizing eHealth solutions in the context of pediatric care at home. Additionally, policymakers and researchers interested in eHealth implementation and improving access to healthcare for parents caring for their children at home may find the study's implications relevant to their work

Sample Size: The study included interviews with parents who went home with their child following hospitalization, and the dimensions of access described in the study reflected both positive and negative aspects of eHealth. The interviews were analyzed qualitatively with directed content analysis, and the findings aimed to provide insights into the experiences and perceptions of parents utilizing eHealth solutions in the context of pediatric care at home

Age Range: The study focused on parents caring for their child at home following pediatric surgery or preterm birth, indicating that the participants were likely parents of young children who had undergone these medical procedures

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access Technology-Based Support

Intervention Description: The intervention in this study involved user engagement with a digital health platform called Maven during pregnancy. The engagement included various activities such as reading articles, watching class recordings, attending live web-based classes, and interacting with dedicated care advocates who are allied health professionals. Additionally, interactions with health care providers, including obstetrician/gynecologists (OB/GYNs), doulas, midwives, mental health providers, nutritionists, and wellness coaches, were also part of the intervention. The study assessed the number of messages sent by users to their care advocates and providers, as well as the number of appointments with providers. The pregnancy trimester of enrollment was used as a proxy for an individual’s time enrolled in the digital platform

Intervention Results: The study found that more users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs and learn medically accurate information. In the adjusted models, all modes of digital service use were associated with avoiding in-person care in a dose-response manner. Users were more likely to avoid in-person care if they reported that Maven helped them recognize warning signs or learn medically accurate information. The study also found that understanding warning signs and learning medically accurate information from the digital platform were independently associated with in-person care avoidance

Conclusion: The study concluded that digital platforms, such as Maven, can be effective in helping pregnant individuals avoid in-person care. The educational pathway suggests that digital platforms can be particularly effective in helping users recognize warning signs and learn medically accurate information, which may help them avoid in-person care by recognizing when it is medically appropriate. The results suggest that digital platforms can provide information and tools that patients need to recognize warning signs, avoid medical misinformation, and decide when in-person care is medically appropriate during pregnancy. This study extends the available literature by assessing the potential influence of access to comprehensive digital health services on emergency room and in-person care avoidance during pregnancy

Study Design: This study is a retrospective cohort analysis that aims to assess the association between user engagement with a digital health platform, Maven, and user reports that the platform helped them avoid in-person care during pregnancy. The study included 5263 users who used the product during pregnancy and reported outcomes after delivery. The study controlled for various factors such as age, race and ethnicity, medical risk score, mental health conditions, pregnancy-related anxiety, parity, pregnancy trimester enrolled, and high Social Vulnerability Index (SVI) . The study found that the use of the digital platform was associated with a better understanding of medically accurate information and warning signs, which in turn was associated with the perceived influence of the digital platform on in-person care avoidance

Setting: The study was conducted as a retrospective cohort analysis, and the setting was not explicitly mentioned in the provided excerpts. However, it focused on assessing the association between user engagement with a digital health platform and user reports that the platform helped them avoid in-person care during pregnancy

Population of Focus: The target audience for this study includes pregnant individuals who were enrolled in the digital platform during their pregnancy between January 2020 and July 2022 and delivered at the time of data analysis in July 2022. These individuals were users of the digital health platform and completed health surveys at both onboarding to the pregnancy program and the postpartum program

Sample Size: The study included a total of 5263 users who used the digital health platform during pregnancy and reported outcomes after delivery

Age Range: The average age of the sample was 32.7 years with a standard deviation of 4.0 years. However, the age range of the sample was not explicitly mentioned in the provided excerpts

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: Mobile health (mHealth) safe sleep messaging increases rates of safe sleep. Bedsharing is more common among breastfeeders. Advice to not bedshare may negatively impact breastfeeding. We compared the impact of safe sleep or breastfeeding mHealth messaging on bedsharing and breastfeeding at 2 to 5 months.

Intervention Results: Overall, exposure to breastfeeding versus safe sleep messaging was not associated with a difference in any breastfeeding at 2 to 5 months (69.3% vs 65.5%, respectively; adjusted odds ratio [aOR] = 1.33 [95% confidence interval, 0.91, 1.94]). Women with shorter planned duration of breastfeeding who received breastfeeding messaging had increased odds of breastfeeding at 2 to 5 months (50% vs 31%; aOR 3.13 [95% CI, 1.47, 6.65]). Mothers who received safe sleep messaging had lower rates of bedsharing overall when compared to breastfeeding messaging (24.8% vs 35.2%; aOR = 0.58 [95% CI, 0.44, 0.78]).

Conclusion: In this large multi-ethnic US sample, receipt of safe sleep mHealth messaging was associated with lower rates of bedsharing without negatively impacting breastfeeding rates. Future research should focus on continued development of interventions to improve adherence to both safe sleep and breastfeeding recommendations.

Intervention Components (click on component to see a list of all articles that use that intervention): Online Material/Education/Blogging Technology-Based Support PATIENT_CONSUMER

Intervention Description: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying.

Intervention Results: Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=-.66, SE 0.08, P=.04 at 8 weeks and β=-.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02).

Conclusion: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education.

Intervention Results: The My Baby Now app was offered to pregnant women 20–30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36–38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8–12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1–T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1–T2 and T1–T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1–T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions.

Conclusion: Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination Nurse/Nurse Practitioner Technology-Based Support

Intervention Description: The purpose of this study was to explore health-related quality of life (HRQL) and family impact in the context of an advanced practice registered nurse-delivered telehealth care coordination intervention for children with medical complexity (CMC). This was a secondary outcomes analysis of a randomized controlled trial with 163 families of CMC in an existing medical home. HRQL and family impact were measured using the PedsQL measurement model.

Intervention Results: Significant predictors of Year 2 child HRQL were baseline HRQL and the presence of both neurologic impairment and technology dependence. There was no significant intervention effect on child HRQL or family impact after 24 months.

Conclusion: Care coordination interventions for CMC may need to incorporate family system interventions for optimal outcomes in a range of quality of life domains.

Study Design: 163 children and their parental caregivers

Setting: A Special Needs Program certified in the Minnesota Health Care Homes Program (medical home for children with medical complexity)

Population of Focus: Children with medical complexity and their parental caregivers. To be eligible for the study, the identified child had to meet at least four of five Children with Special Health Care Needs (CSHCN) Screener criteria, which include the need or use of prescription medications, above routine use of health care services, a functional limitation, need or use of specialized therapies or services, and treatment or counseling for a developmental or behavioral problem.

Age Range: Children aged 2-15 years and their parental caregivers

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: Alongside increasing social media use worldwide, there is an expanding research focus on how social media use affects health behaviours, decisions and perceptions. The objective of this study was to systematically determine if and how breastfeeding is promoted and supported on the popular social media platform Instagram, which currently has over 700 million active users worldwide. To assess how Instagram is used to depict and portray breastfeeding, and how users share perspectives and information about this topic, we analysed 4,089 images and 8,331 corresponding comments posted with popular breastfeeding-related hashtags (#breastfeeding, #breastmilk, #breastisbest, and #normalizebreastfeeding).

Intervention Results: We found that Instagram is being mobilized by users to publicly display and share diverse breastfeeding-related content and to create supportive networks that allow new mothers to share experiences, build confidence, and address challenges related to breastfeeding. Discussions were overwhelmingly positive and often highly personal, with virtually no antagonistic content. Very little educational content was found, contrasted by frequent depiction and discussion of commercial products.

Conclusion: Instagram is currently used by breastfeeding mothers to create supportive networks and could potentially offer new avenues and opportunities to "normalize," protect, promote, and support breastfeeding more broadly across its large and diverse global online community.

Study Design: Qualitative study

Setting: Social media platform: Instgram

Population of Focus: Active Instagram users who shared perspectives and information about breastfeeding with popular breastfeeding-related hashtags

Sample Size: 4,089 images and 8,331 corresponding comments

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Telephone Support Peer Counselor Technology-Based Support COMMUNITY Individual Supports

Intervention Description: The LATCH study was a multisite study designed to test the effectiveness of a 2-way text messaging intervention encouraging exclusive breastfeeding among women enrolled in WIC, combining in-person prenatal and postpartum breastfeeding education and support (breastfeeding peer counseling) with mobile health technology (text messaging). Four WIC BFPC sites in Connecticut participated in the study. The effectiveness of BFPCs was clearly established in the literature; thus, the text messaging intervention was designed to faciliate the BFPCs' work, not replace it.

Intervention Results: Lactation Advice Through Texting Can Help had a significant impact on early contact between participants and BFPCs (odds ratio = 2.93; 95% confidence interval, 1.35–6.37) but did not have a significant impact on EBF (odds ratio = 1.26; 95% confidence interval, 0.54–2.66).

Conclusion: Lactation Advice Through Texting Can Help has the potential to facilitate the work of BFPCs by shortening the time-to-first-contact with clients after giving birth. Research is needed to identify the level of breastfeeding support staff coverage that WIC clinics must have to meet the demand for services created by Lactation Advice Through Texting Can Help.

Study Design: Multisite, single-blind RCT

Setting: WIC breastfeeding peer counselor program/Cell phone

Population of Focus: Low-income women participating in the WIC BFPC program

Sample Size: 174 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Motivational Interviewing Technology-Based Support

Intervention Description: The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors. We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data.

Intervention Results: Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald's T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen's d = .21), but not at 6 or 12 months.

Conclusion: The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.

Study Design: Stepped-wedge cluster randomized trial

Setting: Six Puget Sound Pediatric Research Network Clinics located in Western Washington

Population of Focus: Adolescents aged 13-18 who had a scheduled well-child visit at a participating clinic were invited

Sample Size: 302 participants (135 adolescents in the control group and 167 adolescents in the intervention group)

Age Range: Adolescents aged 13-18

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination Nurse/Nurse Practitioner Technology-Based Support

Intervention Description: A quality improvement project assessed the gaps in care, identified high-risk patients, and developed a novel pediatric trauma care coordinator (PTCC) nursing position to bridge the gap.

Intervention Results: In the 12-month preimplementation period, 14 patients had a costly return to health care (CRH) rate of 14%, compared with the 12-month postimplementation period in which 18 patients had a CRH rate of 0%. Patients received a mean of 21.2 communication events and 14.1 intervention events from the PTCC in the postimplementation period.

Conclusion: The novel PTCC nursing position has addressed a critical gap in the recovery of severely injured children at this pediatric trauma center. A nurse seems to be the ideal type of provider for this position due to the trust relationship with families linked to the medical knowledge to communicate efficiently and effectively with the other providers. The utilization of the existing trauma registry provides a cost-effective tool to collect enhanced outcome data for ongoing quality assessment. The general application of the program to other centers is difficult to determine as local resources vary between pediatric trauma centers. Value assessment and durability of the impact on CRH warrant further investigation.

Study Design: The study is described as a quality improvement project, which indicates that it focuses on implementing and evaluating changes in a healthcare setting to improve patient care and outcomes.

Setting: The setting for the study was a pediatric trauma center. The study was conducted in a single institution, and the pediatric trauma program was developed within this institution.

Population of Focus: The target audience for the study includes healthcare professionals involved in pediatric trauma care, such as trauma nurses, trauma coordinators, pediatric surgeons, and other healthcare providers working in pediatric trauma centers. Additionally, the study may be of interest to hospital administrators, quality improvement professionals, and researchers in the field of pediatric trauma care.

Sample Size: In the 12-month preimplementation period, 14 patients had a CRH rate of 14%, compared with the 12-month postimplementation period in which 18 patients had a CRH rate of 0%.

Age Range: The study does not specify an age range for the pediatric trauma patients included in the program.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Professional Support PATIENT_CONSUMER

Intervention Description: This study aimed to investigate the impact of introducing a smartphone-based daily feedback and counseling platform between women after delivery and a multidisciplinary lactation support team on lactation rates and various maternal and neonatal outcomes. Counseling was provided via a specifically developed application from a multidisciplinary team (obstetricians, nurses, lactation counselors, and psychologist) in an attempt to assist and counsel to maintain lactation.

Intervention Results: A total of 197 patients were recruited, 97 in the App group and 100 in the control group. The 2 groups did not differ in any background or delivery characteristics. The App group showed higher rates of lactation 6 weeks after delivery (96.9% vs 82.0%; P<.001) and 3 months after delivery (81.4% vs 69.0%; P=.049) than the control group. Patients in the App group reported excellent satisfaction from the use of the application and their overall postnatal care.

Conclusion: Our study has provided further information on the growing efficacy of technology platforms in obstetrical care. The introduction of a smartphone-based daily feedback and counseling platform between postpartum patients and a multidisciplinary lactation support team increased the lactation rates after delivery with excellent patient satisfaction.

Intervention Components (click on component to see a list of all articles that use that intervention): WIC Food Package Change Technology-Based Support

Intervention Description: The intervention described in the study focused on the transition of the Washington State Special Supplemental Nutrition Program for Women, Infants, and Children (WA WIC) to remote services and the expansion of food options during the COVID-19 pandemic.

Intervention Results: All WA WIC participants (n = 125,279 in May 2020) experienced the programmatic changes. Participation increased by 2% from March to December 2020 after WA WIC adopted programmatic changes in response to the COVID-19 pandemic. Certification and nutrition education completion rates increased by 5% and 18% in a comparison of June 2019 with June 2020. Food benefit redemption also increased immediately after the food list was expanded in April 2020. Staff and participants were highly satisfied with remote service delivery, predominantly via the phone, and participants appreciated the expanded food options. Staff and participants want a remote service option to continue and suggested various changes to improve service quality.

Conclusion: Participation in WIC and appointment completion rates increased after WA WIC implemented service changes in response to the COVID-19 pandemic. Staff and participants were highly satisfied with remote services, and both desire a continued hybrid model of remote and in-person WIC appointments.

Study Design: Mixed methods design

Setting: Community-based

Population of Focus: WIC staff and participants

Sample Size: 125279

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderation—overseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face-to-face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers.

Intervention Results: Findings identified that local BSF groups are widely used and highly valued for their connection with local face-to-face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self-efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well-being, motivation and breastfeeding duration. As such, they have the potential to add value to local face-to-face services and improve breastfeeding experiences and knowledge in communities.

Conclusion: The findings have important implications to support the development of integrated online interventions to improve public health.

Study Design: Qualitative study

Setting: Social media platform: Breastfeeding Support Facebook groups

Population of Focus: Mothers in the UK using local Breastfeeding Support Facebook groups

Sample Size: 2028 mothers

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER Midwifery HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: One specific form of support that is under researched is the use of Breastfeeding Support Facebook (BSF) groups that are aimed at supporting women in specific local areas, often with links to face to face support. Initial research highlights that mothers’ value these groups but the role that midwives play in offering support to local mothers through these groups has not been examined. The aim of this study was therefore to examine mothers’ perceptions of midwifery support for breastfeeding delivered through these groups, specifically when midwives played an active role in being a group ‘moderator’ or leader.

Intervention Results: Moderation was an important factor in mothers’ experiences, with trained support associated with greater engagement and more frequent visits, impacting on perceptions of group ethos, reliability and inclusivity. Midwife moderation was uncommon (5% of groups) but valued: midwife moderators offered a high level of support to mothers in their groups, with 87.5% having received midwife support often or sometimes and 97.8% rating this useful or very useful. Access to a midwife moderated group was also associated with viewing local face to face midwifery support for breastfeeding more positively. This is a significant finding, highlighting that online support complements face-to-face support in local settings (67% of groups were linked to a physical group), and improves continuity of care (14% of mothers who had midwife moderators received care from them). As such midwife moderated or supported groups have the potential to add value to local face to face services and improve breastfeeding experiences in communities.

Conclusion: The findings have important implications to support the development of integrated online interventions to improve public health.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: To date, most breastfeeding research on social media only focuses on content analysis, and there remains limited knowledge about the social networks of online communities (who interacts with whom), influencers in the breastfeeding space and the diffusion of evidence-based knowledge. This study, grounded in social network theory, aims to better understand the breastfeeding communication landscape on Twitter including determining the presence of a breastfeeding network, communities and key influencers. Further, we characterize influencer interactions, roles and the content being shared.

Intervention Results: The study revealed an overall breastfeeding social network of 3,798 unique individuals (users) and 3,972 tweets with commonly used hashtags (e.g., #breastfeeding and #normalizebreastfeeding). Around one third of users (n = 1,324, 34%) exchanged pornographic content (PC) that sexualized breastfeeding. The non-PC network (n = 2,474 users) formed 144 unique communities, and content flowing within the network was disproportionately influenced by 59 key influencers. However, these influencers had mostly inward-oriented interaction (% composition, E-I index: 47% professionals, -0.18; 41% interested citizens, -0.67; 12% companies, -0.18), limiting opportunities for evidence-based dissemination to the lay public.

Conclusion: Although more tweets about peer-reviewed research findings were sent compared with tweets about nonevidence-based lay recommendations, our findings suggest that it is the lay public who often communicated findings, which may be overcome through a targeted social network-based intervention.

Study Design: Outcome evaluation

Setting: Social media platform: Twitter

Population of Focus: Influencers in the breastfeeding space on Twitter

Sample Size: 3,798 unique individuals (users), 3,962 tweets

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: As recently highlighted by the National Academy of Sciences, there is a need for the scientific community (SC) to diffuse its findings to the public more effectively online, as means to counteract the spread of misinformation. In response to this call, we gathered data from Twitter for one month from major breastfeeding hashtags resulting in an interconnected social network (n = 3,798 users). We then identified 59 influencers who disproportionately influenced information flow using social network analysis. These influencers were from the SC (e.g. academics, researchers, health care practitioners), as well as interested citizens (IC) and companies. We then conducted an ego-network analysis of influencer networks, developed ego maps, and compared diffusion metrics across the SC, IC and company influencers. We also qualitatively analyzed their tweets (n = 711) to understand the type of information being diffused.

Intervention Results: Content analysis of tweets suggest IC are more active than the SC in diffusing evidence-based breastfeeding knowledge, with 35% of their tweets around recent research findings compared to only 12% by the SC. Nonetheless, in terms of outreach to the general public, the two-step networks of SC influences were more heterogenous than ICs (55.7 ± 5.07, 50.9 ± 12.0, respectively, P<0.001).

Conclusion: Collectively, these findings suggest SC influencers may possess latent potential to diffuse research and evidence- based practices. However, the research suggests specific ways to enhance diffusion.

Study Design: Outcome evaluation

Setting: Social media platform: Twitter

Population of Focus: Influencers from the scientific community using major breastfeeding hashtags on Twitter for a month

Sample Size: 59 influencers, 711 tweets

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Professional Support Peer Counselor PATIENT_CONSUMER

Intervention Description: The aims of this study were to describe levels of perceived informational social support among mothers in an online virtual community and to determine which features of the virtual community were perceived most favorably by breastfeeding mothers.

Intervention Results: In regard to online social support specific to information seeking, the reported social support was moderate to high (M=35.53, range=17–48). Most items had a score average of approximately 3, indicating that participants perceived informational support “Pretty often” from their group interactions. Participants in this study had an average Breastfeeding Self-Efficacy–Short Form score of 57.91, indicating a moderately high level of breastfeeding self-efficacy. Content analysis of open-ended items regarding favorable characteristics of the virtual community indicated participants appreciated the immediacy of feedback and the presence of lactation support professionals within the community.

Conclusion: Mothers in the lactation professional-led virtual community perceived moderately high support in health information seeking and experienced moderately high breastfeeding self-efficacy. Additional work is needed to determine the impact of participation in virtual communities on breastfeeding outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Telephone Support Technology-Based Support COMMUNITY Individual Supports

Intervention Description: To test the effects of weekly SMS for improving infant feeding practices and infant weight. SMS were sent automatically using a web-based SMS messaging platform from the time the participant enrolled in the study until the end (4 months later). Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for 4 months. Intervention SMS were created with a focus on reinforcing WIC messages on breastfeeding, preventing overfeeding, delaying introduction of solid foods, and delaying and reducing baby juice comsumption. A total of 18 messages (1 per week for 4 months) were sent. All messages were written at a grade 5 level in Spanish for PR or English for HI.

Intervention Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.

Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.

Study Design: Multisite RCT

Setting: WIC programs in Puerto Rico and Hawaii/Cell phone

Population of Focus: Caregivers of infants 0-2 months old participating in the WIC program

Sample Size: 170 participants (86 control and 84 intervention)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Educational Material PATIENT_CONSUMER

Intervention Description: To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas.

Intervention Results: A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = −18.70, p < 0.01) and attitudes (t = −2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers’ practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses.

Conclusion: The mobile intervention improved participants’ knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: Social media crosses socioeconomic and geographic lines and can inform and empower people, increase communication speed, and mobilize partnerships. Through the dissemination of standardized messages and graphics, social media can be optimized for the delivery of evidence-based nutrition information. In 2014, the USDA launched a mobile-responsive Web site to assist WIC staff in engaging participants and community partners. Resources included posters, brochures, videos, widgets, graphics, and BF peer counseling training. Recognizing the opportunity for spreading messages via social media, the Web site was enhanced with the addition of a social media toolkit for World Breastfeeding Week/National Breastfeeding Month (August, 2016). The goal of the project was to create sample graphics and messages based on the campaign that could be used by WIC agencies and partners to reach participants, eligible participants, and the public. Messages were developed using content from the Loving Support campaign materials and Loving Support Peer Counseling Training. Agencies were encouraged to link to the Loving Support Web site and use the hashtag #WICLovingSupport in their posts. Agencies could also customize the messages and graphics as needed to promote their own activities and events. The toolkit included Facebook covers and posts, Twitter headers and posts, a Twibbon, an Instagram post, and an e-card. A guide to using the toolkit with sample messages was created as well. The Figure shows sample images and messages.

Intervention Results: The toolkit was launched on July 12, 2016 and received 4,319 page views by the end of August. Overall there were 9,432 downloads of all Loving Support materials and 29,745 page views to the Loving Support Web site. This was a 50% increase in page views and a 17% increase in downloads over the previous month, before the launch of the toolkit. Use of the toolkit continued since August with 1,507 page views between August, 2016 and February, 2017. The number of users for that same period was 5,007 (new and returning users). There were 2,342 downloads of social media graphics, with Facebook covers and posts, the e-card, and Instagram posts as the most downloaded items. The Twibbon campaign had 36 supporters. A TweetReach snapshot report from August 2 to August 6 (during World Breastfeeding Week) showed that the hashtag #WICLovingSupport had 60 tweets from 40 contributors, 287,820 accounts reached (the number of people who likely saw content), and 362,607 impressions (the number of times people likely reached).

Conclusion: Translating policy and guidance into action-oriented messages that WIC agencies can easily use and disseminate can increase the exposure of evidence-based nutrition messages. Although it is a relatively low-cost communication strategy, social media involves a high cost in time and attention needed to maintain an active presence.8 By providing a ready-to-go social media toolkit, the Food and Nutrition Service was able to offer consistent messaging, but it also reduced WIC staff workload and reached many people with information about BF promotion and support.

Study Design: Program evaluation

Setting: Social media platforms: Facebook, Twitter, and Instagram

Population of Focus: WIC staff

Sample Size: 5,007 new and returning users

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers Technology-Based Support

Intervention Description: The intervention aligns with a discernable strategy and involves a multicomponent approach. The West Virginia Children’s Access Network (WVCAN) project implemented a multidisciplinary telehealth model into three school-based health centers (SBHCs) in West Virginia. The primary outcomes of the intervention were to increase youth access to psychiatric care and reduce wait times, with secondary outcomes focusing on satisfaction and sustainability . The intervention involved the use of comanaged direct care and consultation and stabilization models, which included the use of a child and adolescent psychiatrist to assist patients with diagnostic clarity and stabilization followed by a transition back to the SBHC primary provider. Case consultations were offered for acute crises or established patients . This intervention aligns with the strategy of providing consultative care to primary care providers, which has been recommended as an approach with robust evidence for improving patient care . The WVCAN project aimed to provide school-based psychiatry services in West Virginia’s rural areas by child psychiatrists and psychologists trained in telepsychiatry, addressing disparities for children with mental health needs in schools . The intervention involved the use of telehealth equipment and the services of a part-time child psychiatrist, as well as ongoing support from case managers and periodic self-assessments to examine strengths and weaknesses of the program

Intervention Results: The primary referral sources for the program were largely initiated by local therapists, case managers, parents, teachers, and school counselors, with lack of access to local specialists and long wait times cited as the most common referral reasons. A total of 98 appointments were provided, of which 65 were kept, for a no-show rate of 17%. Two hospitalizations were reported among the served youth, and the full impact of the project will be discussed when all data are available

Conclusion: The conclusion emphasizes the importance of telehealth as an efficacious and cost-effective model to screen and provide specialty services to children in rural areas, while also increasing compliance. It also highlights the potential of the WVCAN project as an exemplar of a school–telepsychiatry partnership that brings services to the setting where youths are most accessible, thereby disrupting the known cycle of underuse of psychiatric care experienced by youths who wait for service

Study Design: The PDF describes the strategies used to implement and integrate the telehealth model, as well as the barriers, challenges, and judicious resource use involved in the WVCAN project. It also reports on the number of appointments provided, the rate of appointments kept, and the occurrence of hospitalizations among the served youth. However, it does not provide statistical analyses or discuss the significance of these findings in a quantitative or statistical sense.

Setting: The study setting described in the PDF "An Innovative Approach to Care: Integrating Mental Health Services Through Telemedicine in Rural School-Based Health Centers" is focused on rural areas in West Virginia, specifically within school-based health centers (SBHCs). The document discusses the implementation of a multidisciplinary telehealth model into three SBHCs in West Virginia, located in Barbour, Pocahontas, and McDowell counties. The primary focus of the study setting is on integrating mental health services into these rural school-based health centers using telemedicine to address the mental health needs of children and adolescents in underserved areas. The setting reflects the specific geographic and healthcare context of rural West Virginia, where access to specialized mental health care may be limited. Therefore, the study setting is centered on the integration of telemedicine-based mental health services within rural school-based health centers in West Virginia, highlighting the unique challenges and opportunities associated with providing mental health care in this context.

Population of Focus: The target audience for the PDF "An Innovative Approach to Care: Integrating Mental Health Services Through Telemedicine in Rural School-Based Health Centers" includes professionals and stakeholders involved in mental health care, telemedicine, and school-based health services. This may encompass healthcare providers, mental health professionals, educators, policymakers, and individuals interested in addressing mental health disparities in rural communities through innovative telehealth models. The document provides insights into the implementation, challenges, and potential benefits of integrating mental health services through telemedicine in rural school-based health centers, making it relevant to professionals and stakeholders seeking to improve access to mental health care for children and adolescents in underserved areas. Additionally, individuals and organizations involved in telehealth program development, policy advocacy, and addressing mental health disparities in rural populations may also find the content of the PDF relevant to their work.

Sample Size: The PDF does not explicitly state the sample size of the West Virginia Children’s Access Network (WVCAN) project. The document primarily provides an overview of the strategies used to implement and integrate the telehealth model, as well as the barriers, challenges, and judicious resource use involved in the project. It reports on the number of appointments provided, the rate of appointments kept, and the occurrence of hospitalizations among the served youth, but it does not provide a specific sample size in the traditional sense of a research study.

Age Range: The PDF does not explicitly mention the specific age range of the youths served by the West Virginia Children’s Access Network (WVCAN) project. However, it focuses on increasing youth access to psychiatric care and reducing wait times for youths who were unable to access these services through other means. The project aimed to provide school-based psychiatry services in West Virginia’s rural areas by child psychiatrists and psychologists trained in telepsychiatry. Therefore, it can be inferred that the project targeted children and adolescents of school age. While the PDF does not provide a specific age range, it emphasizes the importance of addressing the mental health needs of children and adolescents in rural areas through the WVCAN project.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention is this study includes the use of machine learning methods to predict the risk of prenatal depression based on psychosocial screening data. The study analyzes the effectiveness of this approach and suggests that it can be used to improve clinical practice in identifying and addressing prenatal depression. The intervention described in the study aligns with a discernable strategy of using technology and data analysis to improve mental health screening and care. It is not a study that analyzes a multicomponent intervention.

Intervention Results: The results of the study include the utilization of machine learning (ML) methods on data from the PROMOTE, a psychosocial screening tool, to quantify the risk for prenatal depression for individual patients and identify contributing factors that impart greater risk for depression . The study also illustrates how vulnerabilities identified in the PROMOTE can be used to classify women at risk for under-detected outcomes, such as depression, using ML methods . Additionally, the study provides potential individualized output from their methods to highlight the risk for multiple adverse outcomes, and it discusses the important research relevance in understanding resilience and why some women with several risk factors and high probability of depression remain healthy.

Conclusion: Results affirm the value of the PROMOTE as a psychosocial screening tool for prenatal depression and the benefit of using it in conjunction with ML methods. Using such methods can help detect underreported outcomes and identify what in patients’ lives makes them more vulnerable, thus paving the way for effective individually tailored precision medicine.

Study Design: However, based on the information provided, the study appears to utilize a retrospective observational study design, as it applies machine learning methods to analyze data from the PROMOTE psychosocial screening tool to predict the risk of prenatal depression and identify contributing factors , , . Additionally, the study discusses the potential implications for future clinical practice and research, indicating an observational and analytical approach to understanding and addressing prenatal depression

Setting: The study was conducted in an outpatient prenatal clinic associated with a large university hospital between June 2019 and November 2020 . The specific location or name of the university hospital is not provided in the excerpts.

Population of Focus: The target audience for the study includes healthcare professionals, researchers, and practitioners involved in prenatal care, perinatal mental health, and psychosocial screening. Additionally, the findings of the study may be of interest to professionals in the fields of obstetrics, gynecology, psychiatry, and public health, as well as individuals and organizations involved in the development and implementation of psychosocial screening tools and machine learning applications in healthcare.

Sample Size: The provided excerpts indicate that out of 1844 patients who completed the PROMOTE psychosocial screening tool during their first visit to an outpatient prenatal clinic associated with a large university hospital between June 2019 and November 2020, 1715 had a complete EPDS in their medical chart from the first prenatal visit and were included in the current analysis

Age Range: The provided excerpts do not explicitly mention the specific age group of the participants in the study. However, the study focuses on utilizing machine learning methods on data from the PROMOTE, a psychosocial screening tool, to quantify the risk for prenatal depression for individual patients and identify contributing factors that impart greater risk for depression , . Given the focus on prenatal depression and psychosocial screening in the context of pregnancy, it can be inferred that the study's participants are likely to be pregnant individuals of reproductive age

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: The present study aims at evaluating the impact of the COVID-19 pandemic on breastfeeding consultations in LactApp (a mobile application [app] for m-Health focused on breastfeeding support, www.lactapp.com) during the COVID-19 pandemic.

Intervention Results: LactApp active users increased by 12,092 users (p < 0.001) during the COVID-19 outbreak and confinement and queries consulted in LactApp also significantly increased by 10,899 queries per month after the pandemic outbreak. The breastfeeding topics that significantly increased are those related to growth spurts, breastfeeding stages, breastfeeding technique, breast pain and mastitis, problems with infants not gaining weight correctly, hypogalactia, increased milk demand, and relactation. These findings are important to understand the potential of online tools when face-to-face professional support is unavailable.

Conclusion: Critical issues in breastfeeding establishment were highly consulted and significantly increased in the app during the pandemic. We believe that LactApp was a useful tool for breastfeeding support when women could not obtain appropriate support elsewhere. LactApp might be considered a powerful tool to identify critical issues of breastfeeding and trends in an automatized manner.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: The aim of this study is to identify breast-feeding challenges, facilitators and assets and to describe how community assets via social media could build community resilience to pandemic’s and disaster’s effects.

Intervention Results: In phase one, breast-feeding ‘Challenges’ identified were lack of support from peers and family, lack of supportive policies, lack of knowledge and maternal stress related to political instability, COVID-19 and economic crisis. ‘Assets and facilitators’ included community support and donations. In phase two, analysis revealed how assets were being used on social media platform to build community resilience post crisis, through access to social support in challenging times, community engagement, material resources and transformative potential.

Conclusion: Challenges faced during breast-feeding were diminished due to the support and assets received on a Facebook breast-feeding support group, and social media has been shown to be an important community asset implicated in empowering women to breastfeed and to build community resilience in moments of crisis.

Intervention Components (click on component to see a list of all articles that use that intervention): Online Material/Education/Blogging Technology-Based Support PATIENT_CONSUMER

Intervention Description: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization.

Intervention Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3.

Conclusion: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination Technology-Based Support Expert Support (Provider)

Intervention Description: The quality of children's health is compromised by poor care coordination between primary care providers (PCPs) and specialists. Our objective was to determine how an electronic consultation and referral system impacts referral patterns and PCP-specialist communication. The primary care clinic at Boston Children's Hospital piloted an electronic referral and consultation system with the neurology and gastroenterology departments from April 1, 2014, to October 31, 2016. PCPs completed an electronic consult form, and if needed, specialists replied with advice or facilitated expedited appointments. Specialist response times, referral rates, wait times, and completion rates for specialty visits were tracked. PCPs and specialists also completed a survey to evaluate feasibility and satisfaction.

Intervention Results: A total of 82 PCPs placed 510 consults during the pilot period. Specialists responded to 88% of requests within 3 business days. Eighteen percent of specialty visits were deferred and 21% were expedited. Wait times for specialty appointments to both departments significantly decreased, from 48 to 34 days (P < .001), and completion rates improved from 58% to 70% (P < .01), but referral volumes remained stable (25 per month to 23 per month; P = .29). Most PCPs said the Shared Care system facilitated better communication with specialists (89%) and enabled them to provide superior patient care (92%). Specialists reported that the system required a minimal amount of time and enabled them to educate PCPs and triage referrals.

Conclusion: Implementation of an electronic referral and consultation system was feasible and provided timely access to specialty care, but did not affect referral volume. This system could serve as a model for other health care organizations and specialties.

Study Design: Program evaluation

Setting: A primary care clinic at Boston Children’s Hospital (BCH), which is a hospital-based, urban pediatric clinic serving approximately 16,000 patients

Population of Focus: Primary care providers (PCPs) at the primary care clinic at Boston Children’s Hospital (BCH) who placed electronic consults using the Shared Care system; Patients who were referred through the Shared Care system

Sample Size: 82 primary care providers (PCPs) who placed 510 electronic consults using the Shared Care system during the pilot period; A total of 426 unique patients were referred through the Shared Care system during the study period

Age Range: Adult providers; Children and youth ages 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention focuses on the development of multivariable models to predict perinatal depression using patient-reported survey responses. The models can be used to identify patients who may benefit from certain interventions, such as additional education about depression or more regular check-ups and depression screening.

Intervention Results: The study developed five models that can predict the risk of perinatal depression within each trimester and in two post-natal periods using survey responses as early as week 4 of pregnancy with modest performance. The models need to be externally validated and prospectively tested to ensure generalizability to any pregnant patient. The study found that the models could be used to identify patients who would benefit from certain interventions, such as additional education about depression or more regular check-ups and depression screening. However, the study also noted limitations, such as the small dataset and the use of the EPDS score as a proxy for depression.

Conclusion: The five models can predict risk of perinatal depression within each trimester and in two post-natal periods using survey responses as early as week 4 of pregnancy with modest performance. The models need to be externally validated and prospectively tested to ensure generalizability to any pregnant patient.

Study Design: The study utilized a prospective cohort design, where 858 participants completed a baseline self-reported survey at weeks 4–10 of pregnancy. The participants were followed longitudinally throughout pregnancy and after delivery, with the survey containing the EPDS administered at multiple time points. The study developed multivariable models to predict perinatal depression using the survey responses as predictors

Setting: The study setting for this research was conducted online, with participants being active on the BabyCenter website between August 25 to September 19, 2016, and consenting to participate. The study did not specify a physical location, as it was conducted virtually through the BabyCenter platform

Population of Focus: The target audience for this study includes healthcare professionals involved in perinatal care, such as obstetricians, gynecologists, midwives, and mental health professionals. Additionally, researchers and policymakers in the field of perinatal mental health may also find the findings and implications of this study relevant. The study's focus on developing models to predict perinatal depression risk and its potential implications for early intervention and personalized care make it pertinent to professionals involved in maternal and perinatal health.

Sample Size: The study initially had 5,028 BabyCenter users who showed interest in completing the survey. However, 3,471 participants were excluded due to various reasons, such as pregnancy outside the weeks of interest, not completing the screening section, not being pregnant, participating in other research, age less than 18, located outside the US, and being male. This left 1,557 participants qualified to participate, and 1,179 (76%) completed the baseline survey. The study only used the 858 participants at 4–10 weeks of their pregnancy who completed the baseline survey. 554, 528, 555, 469, and 515 of these participants filled in the EPDS survey during trimester 1 (week 12 or 13), trimester 2 (week 21), trimester 3 (week 32), week 4 post-delivery, and week 12 post-delivery, respectively

Age Range: The study did not report the specific age range of the participants. However, the eligibility criteria for the study included being 4-10 weeks pregnant at enrollment and being over the age of 18, so it can be inferred that the participants were adult women

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Educational Material Technology-Based Support

Intervention Description: Partners For Kids (PFK) is an accountable care organization caring for pediatric Medicaid beneficiaries in Ohio. PFK QI specialists recruited practices to develop QI projects around increasing well care visit rates (proportion of eligible children with well care visits during calendar year) for children aged 3-6 years and adolescents. The QI specialists supported practice teams in implementing interventions and collecting data through monthly or bimonthly practice visits.

Intervention Results: Ten practices, serving more than 26 000 children, participated in QI projects for a median of 8.5 months (IQR 5.3-17.6). Well care visit rates in the QI-engaged practices significantly improved from 2016 to 2018 (P < .001 for both age groups). Over time, well care visit rates for 3- to 6-year-old children increased by 11.8% (95% CI 5.4%-18.2%) in QI-engaged practices, compared with 4.1% (95% CI 0.1%-7.4%) in non-engaged practices (P = .233). For adolescents, well care visit rates increased 14.3% (95% CI -2.6% to 31.2%) compared with 5.4% (95% CI 1.8%-9.0%) in QI-engaged vs non-engaged practices over the same period (P = .215). Although not statistically significant, QI-engaged practices had greater magnitudes of rate increases for both age groups.

Conclusion: Through practice facilitation, PFK helped a diverse group of community practices substantially improve preventive visit uptake over time. QI programs in primary care can reach patients early to promote preventive services that potentially avoid costly downstream care.

Study Design: Prospective cohort study

Setting: Community-based primary care practices serving pediatric Medicaid beneficiaries. These practices were geographically distributed throughout central and southeast Ohio, with a mix of urban and rural locations.

Population of Focus: Community-based primary care practices in Ohio, specifically those providing care to pediatric Medicaid recipients. These practices were actively engaged with Partners For Kids (PFK) and were involved in the Healthy Children Initiative, a quality improvement effort aimed at increasing well care visit rates for pediatric Medicaid patients.

Sample Size: 10 community-based primary care practices that were actively engaged in the Healthy Children Initiative. These practices served more than 26,000 pediatric Medicaid beneficiaries.

Age Range: The patient population served by these practices included pediatric Medicaid beneficiaries, with a focus on children aged 3-6 years and adolescents.

Intervention Components (click on component to see a list of all articles that use that intervention): Telelactation Technology-Based Support PATIENT_CONSUMER

Intervention Description: To analyse the experience of Spanish paediatricians after the forced digitization of consultations due to the pandemic.

Intervention Results: 306 health professionals participated in the study Most of them agreed on the use of the internet and social networks during the pandemic, referring to mail or WhatsApp® as usual channels of communication with their patients' families. There was a great agreement among paediatricians that the evaluation of newborns after hospital discharge and establishing methodologies that allow childhood vaccination and the identification of subsidiary patients for face-to-face evaluation were necessary although the limitations of the lockdown. The idea that telephone and digital consultations have optimized the consultation time and that they will probably continue after the end of the pandemic was generally accepted. No changes in adherence to breastfeeding or the start of complementary feeding were referred to, but an increase in the duration of breastfeeding and the appearance of frequent hoaxes in social networks concerning infant feeding were found.

Conclusion: It is necessary to analyse the impact of telemedicine in paediatric consultations during the pandemic to evaluate its effectiveness and quality to maintain it in routine paediatric practice.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Education on Disease/Condition Assessment (patient/consumer)

Intervention Description: Youth account for half of new sexually transmitted infections (STIs) in the United States annually. Barriers to STI prevention include a lack of accurate sexual and reproductive health (SRH) education and low STI testing. We sought to obtain youth feedback on a digital health platform prototype designed to address these barriers. The platform prototype included SRH content, free STI testing and treatment, and anonymous question submission. Five focus group discussions, each lasting 45-60 minutes with 5-6 youth living in a high-prevalence STI region (Baltimore, Maryland), were conducted. Thematic analysis was conducted.

Intervention Results: There were 28 participants with a mean age of 15.9 years (range 14-19), among whom 89% self-identified as female, 57% Black/African American, 29% Asian American, 14% White, and 7% Hispanic/Latino. Youth felt that the prototype platform was comprehensive and understandable. They suggested adding peer reviews to increase trustworthiness.

Conclusion: Youth reported that the platform (violetproject.org) was an acceptable tool for SRH education and STI testing. Participants expressed enthusiasm and willingness to use the platform as a reliable SRH educational tool to combat medical misinformation on the Internet and a non-clinic-based source of STI testing. This platform could fill gaps in access to SRH care and education for youth.

Study Design: Qualitative study

Setting: Public high schools and community colleges in Baltimore, Maryland

Population of Focus: Adolescents and young adults living in Baltimore, Maryland

Sample Size: 28 adolescents and youth

Age Range: Adolescents and youth 14-19 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Material Other Education Telephone Support Partner-Level Intervention Technology-Based Support COMMUNITY Social Supports Individual Supports

Intervention Description: Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. Mobile health (mHealth) interventions employing digital technologies provide a rapidly evolving means of engaging fathers and providing them with information and support to address their needs related to both breastfeeding and transitioning to fatherhood. The Parent Infant Feeding Initiative (PIFI) was a 4-arm, randomized controlled trial conducted in Perth, Australia. The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. The primary outcomes were duration of exclusive and any breastfeeding. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions.

Intervention Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

Conclusion: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

Study Design: RCT

Setting: Antenatal breastfeeding class/Online

Population of Focus: Couples from public and private hospitals in Perth, Australia

Sample Size: 1426 couples

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Peer Counselor Home Visits PATIENT_CONSUMER

Intervention Description: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF).

Intervention Results: The intervention was delivered as intended, maintained over the study period, and had high acceptability ratings. There were statistically significant differences in all outcomes between groups. The intervention group had a significantly higher likelihood of EBF at 6 months compared to the control group (adjusted odds ratio 3.57, 95% confidence interval 1.80–7.07).

Conclusion: Integration of mHealth with community-based peer counselors to educate women about EBF is feasible and acceptable in rural India and impacts maternal breastfeeding behaviors.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The New York City (NYC) Department of Health and Mental Hygiene released the Teens in NYC mobile phone application (app) in 2013 as part of a program to promote sexual and reproductive health among adolescents aged 12-19 in NYC. The app featured a locator that allowed users to search for health service providers by sexual health services, contraceptive methods, and geographic locations. We analyzed data on searches from the Where to Go section of the app to understand the patterns of use of the app’s search functionality.

Intervention Results: From January 7, 2013, through March 20, 2016, the app was downloaded more than 20 000 times, and more than 25 000 unique searches were conducted within the app. Results suggest that the app helped adolescents discover and access a wide range of sexual health services, including less commonly used contraceptives.

Conclusion: Those designing similar apps should consider incorporating search functionality by sexual health service (including abortion), contraceptive method, and user location.

Study Design: Program evaluation

Setting: Teens in NYC mobile app developed and implemented by the New York City Department of Health and Mental Hygiene in collaboration with the Bronx Teens Connection Youth Advisory Board

Population of Focus: Adolescents aged 12-19 in New York City

Sample Size: Mobile app was downloaded more than 20,000 times; More than 25,000 unique searches were conducted within the app

Age Range: Adolescents aged 12-19 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Assessment (patient/consumer) Expert Support (Provider)

Intervention Description: ChilledOut Online is a treatment program based on the Cool Kids and Chilled anxiety management program developed at Macquarie University, Sydney, Australia [52]. The program teaches CBT strategies for adolescents through eight online modules of approximately 30 minutes, with a focus on psychoeducation, cognitive restructuring and graded exposure. To allow for flexibility and personal learning preferences, adolescents were able to access all modules at treatment start. To guide progress through the program, adolescents were however encouraged to complete all eight modules (and module content) in the order they appeared within the 14-week intervention period, after which they would have access to the web site for another three months. Program content such as goal setting, realistic thinking, problem solving, and assertiveness, is presented through a combination of multimedia formats, i.e. text, audio, illustrations, cartoons, worksheets, and video vignettes.

Intervention Results: Lending support to our main hypothesis, participants receiving ICBT demonstrated significant improvements at post-treatment compared to participants in the WL condition across all raters on diagnostic severity and level of anxiety symptoms (CSR and SCAS). The between-group ES’s found for CSRprim and CSRall in the present study (d = 0.65 and d = 0.83, respectively) are in the lower end of those found in other similar WL controlled studies.

Conclusion: This study demonstrated the Danish version of ChilledOut Online to be efficacious and feasible in relieving symptoms of anxiety in adolescents. As such, the study supports previous findings of similar guided ICBT interventions and helps build a strong foundation for future research in and implementation of ICBT in mental health services for adolescents with anxiety disorders.

Study Design: Randomized controlled trial

Setting: Online

Population of Focus: Adolescents with anxiety disorders

Sample Size: 70

Age Range: 13-17 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide) Technology-Based Support Training (Parent/Family)

Intervention Description: 1. Motivational interviewing techniques to help women identify and change their substance use and sexual risk behaviors. 2. Education on the risks associated with substance use and risky sex during pregnancy. 3. Skills training on how to negotiate safer sex practices and use condoms effectively. 4. Personalized feedback on substance use and sexual risk behaviors. 5. Booster sessions to reinforce the intervention content and provide additional support.

Intervention Results: There were consistently very high ratings of acceptability of the intervention, ranging between 6.3 and 6.8 on a 1-7 scale. At the 4-month follow-up, participants in the intervention arm reported a significantly larger reduction (54%) in any marijuana or alcohol use compared with participants in the control group (16%) (p = 0.015) based on two-group clustered logistic regression using a generalized estimating equations approach. There was a higher reduction in condomless vaginal sex at follow-up in the health checkup for expectant moms (HCEM) arm than control (27% vs. 5%), although this was not significant (p = 0.127).

Conclusion: The results of this pilot study are encouraging with respect to the acceptability and preliminary efficacy of an intervention in reducing alcohol/marijuana use and condomless sex during pregnancy, supporting the next step of testing the intervention in a larger sample.

Study Design: The study design was a randomized controlled trial (RCT) . The study randomized 50 pregnant women who met specific inclusion criteria into either the computer-delivered brief intervention group or the control group

Setting: prenatal clinic in a large inner-city hospital

Population of Focus: pregnant women who met specific inclusion criteria, including those who endorsed condomless vaginal or anal sex at least once in the past 30 days, had an unplanned pregnancy, and reported current alcohol or drug use or were at risk for prenatal alcohol/drug use.

Sample Size: 50 women

Age Range: average age 24 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Lactation Consultant Other Education Technology-Based Support HEALTH_CARE_PROVIDER_PRACTICE Other (Provider Practice)

Intervention Description: Telelactation is one tool that can be leveraged to increase access to International Board Certified Lactation Consultants (IBCLCs) in rural settings. Telelactation services connect breastfeeding women to remotely located IBCLCs through audio-visual technology. The Telehealth for Mothers to Improve Lactation Confidence (Tele-MILC) randomized controlled trial evaluated the feasbility and impact of telelactation via personal electronic devices on breastfeeding duration and exclusivity among rural mothers. Participants randomized to the telelactation arm were given an orientation to Pacify Health's telelactation app by hospital nurses. The nurses showed participants how to download the app on a personal device (smartphone or tablet), provided a coupon code for free, umlimited video calls, and encouraged participants to conduct a test call on their own device or on a demonstration device. After the orientation, participants could request umlimited, on-demand video calls with IBCLCs through the app for as long as they desired. The app used in the trial aimed to provide video calls within seconds of a visit request by a mother. The app is also HIPAA-compliant, and the telelactation services it provides involves a large network of geographically dispersed IBCLCs available to take video calls 24 hours a day.

Intervention Results: Among participants in the telelactation arm, 50% (47/94) reported participating in video calls. At 12 weeks, 71% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the ITT model (3% difference, P = .73), whereas 73% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the IV model (5% difference, P = .74). Among participants who were still breastfeeding at 12 weeks, 51% participants in the telelactation arm were breastfeeding exclusively versus 46% of control participants in the ITT model (5% difference, P = .47), whereas 56% of participants in the telelactation arm were breastfeeding exclusively versus 45% of control participants in the IV model (11% difference, P = .48). In all models, participants in the telelactation arm were breastfeeding at higher rates; however, differences were not statistically significant.

Conclusion: This trial demonstrated that telelactation can be implemented with a rural underserved population. Though this trial was not powered to detect differences in breastfeeding duration and exclusivity, and none were observed, telelactation remains a promising approach for further investigation. ClinicalTrials.gov Identifier: NCT02870413.

Study Design: RCT

Setting: Critical Access Hospital in North-Central PA/Online

Population of Focus: Postpartum women who had initiated breastfeeding and planned to contine after hospital discharge

Sample Size: 203 women (102 for intervention and 101 for control)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support Professional Support

Intervention Description: The study aimed to determine the effect of breastfeeding support through social media on women’s breastfeeding self-efficacy. Methods

Intervention Results: At 3 and 6 months there was a statistically significant difference in BSES-SF mean scores between the intervention and control groups (p < 0.05). BSES-SF scores in the intervention group were higher at 3 and 6 months compared with baseline, while BSES-SF scores in the control group were lower at 6 months compared with baseline.

Conclusion: Women’s breastfeeding self-efficacy was improved through a social media-based teaching and counselling intervention. Health care professionals should make use of social media tools to improve women’s breastfeeding self-efficacy and encourage continuity of breastfeeding

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention described in the article is the development and pilot-testing of a mobile phone application, the MGH Perinatal Depression Scale (MGHPDS), which aims to assess psychiatric symptomatology, with a focus on depressive symptoms, in pregnancy and the postpartum period . The app is designed to allow for the collection of big data on perinatal women and the longitudinal assessment of risk factors contributing to depression during this period in a minimally invasive manner.

Intervention Results: The study collected cross-sectional mental health data on over 700 women during the perinatal period, including women from over 30 countries. The findings revealed that over half of the women during pregnancy and over 70% of women in the postpartum had a depression score indicative of clinical depression. The study also reported on constructs commonly comorbid with depression, including anxiety, sleep dysregulation, and perceived stress , . These findings highlight the potential impact of the app in identifying women at risk for perinatal depression and the need for improved tools and approaches for detecting depression during the perinatal period.

Conclusion: This report provides preliminary findings from a pilot study of a digital screening app for perinatal depression expiring potential for app reach, engagement, and user demographics and mental health symptoms. With mainly passive recruitment efforts, we collected cross-sectional mental health data on over 700 women during the perinatal period, including women across over 30 countries. We report on mean depression scores among women during pregnancy and the postpartum as well as on constructs that are commonly comorbid with depression, including anxiety, sleep dysregulation, and perceived stress. Over half of the women during pregnancy and over 70% of women in the postpartum had a depression score indicative of clinical depression. Future research directions for this work and potential for public health impact are discussed, including longitudinal data collection and analyses of symptomology over time and embedding evidence-based digital therapeutics into the app as a means to increase access to mental health services.

Study Design: The study design used in the research is a pilot study. The authors conducted a preliminary test of the first version of the MGHPDS to explore the potential for reaching perinatal women on a global scale with the app, as well as user engagement with the app over time. The study also explored demographics and mental health symptom profiles among app users. The findings from this initial exploratory pilot study will inform the refinement of the app and data collection methods

Setting: The study was conducted in various settings, including the Departments of Psychiatry, Primary Care, and Obstetrics at Mass General Brigham, as well as MGH-affiliated community health centers. Recruitment efforts were also made through the website www.womensmentalhealth.org and its affiliated listserv. Additionally, the study was promoted during presentations at national meetings for psychiatrists, obstetricians, and family practitioners. Subjects could also join the study by searching for or coming across the application within Apple or Google application stores

Population of Focus: The target audience for the study is perinatal women, specifically those who were pregnant or within 12 months postpartum, between the ages of 18-45, and willing and able to fill out questionnaires about their mood, sleep, anxiety, and stress levels using a mobile phone application

Sample Size: The study included a total of 786 participants

Age Range: The study included women between the ages of 18-45

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support

Intervention Description: The intervention involves the development of a PPD prediction model that can be integrated with the EHR system as clinical decision support (CDS) or with a mobile or web platform to be used as a patient-facing CDS in a future phase of the study. This aligns with the strategy of using technology to improve healthcare delivery and patient outcomes. The study focuses on developing a predictive model for PPD using EHRs and machine learning algorithms.

Intervention Results: The study resulted in the development of a predictive model for postpartum depression (PPD) using electronic health records (EHRs) and machine learning algorithms. The model achieved a best prediction performance with an area under the curve (AUC) of 0.79 . The study demonstrated the feasibility of using EHR data for PPD risk prediction based on information available during prenatal care. It also identified several disease diagnoses and medications during pregnancy that potentially contribute to the prediction of PPD . The findings suggest that screening for PPD should consider health and health service utilization throughout the pregnancy period, and that more comprehensive information provides improved prediction performance. The study also highlighted the potential of integrating machine learning models within the EHR system as clinical decision support (CDS) to enable effective screening for expectant mothers at risk of developing PPD . In conclusion, the study demonstrated promising results in PPD prediction using a machine learning approach with information on patient demographics, diagnoses, and medications available from EHRs.

Conclusion: In this pilot study, we demonstrate promising PPD prediction results using a machine learning approach with information on patient demographics, diagnoses, and medications available from EHRs. Our goal is to create an accurate PPD prediction model to identify risk factors for PPD and facilitate effective screening of mothers who may require early intervention for PPD using an EHR. We envision that the model may be integrated with the EHR system for a provider-facing CDS or with a mobile or web platform to be used as a patient-facing CDS in a future phase of the study.

Study Design: The study design was a retrospective cohort study that used electronic health records (EHRs) from Weill Cornell Medicine and NewYork-Presbyterian Hospital between 2015-17 as the data source. The study population included pregnant women who had a fully completed antenatal care procedure at the hospital and had a singleton birth. The exclusion criteria were those with unknown pregnancy length of gestational weeks, with missing information from at least one trimester during pregnancy, and those with diagnoses of PPD before pregnancy. The study used six machine learning algorithms, including L2-regularized Logistic Regression, Support Vector Machine, Decision Tree, Naïve Bayes, XGBoost, and Random forest, to develop a predictive model for PPD. The model's performance was evaluated using the area under the receiver-operator curve (AUC) in 10-fold cross-validation

Setting: The study was conducted using electronic health records (EHRs) from Weill Cornell Medicine and NewYork-Presbyterian Hospital between 2015-17. The study setting was therefore a hospital-based setting in New York, USA, where the EHRs were collected and analyzed to develop a predictive model for postpartum depression (PPD) using machine learning algorithms

Population of Focus: The target audience for this study includes healthcare professionals, researchers, and data scientists interested in leveraging electronic health records (EHRs) and machine learning techniques to predict postpartum depression (PPD) and identify risk factors for effective screening and early intervention. Additionally, the findings may be of interest to stakeholders involved in maternal healthcare and the development of clinical decision support interventions for PPD.

Sample Size: The study identified 9,980 episodes of pregnancy within the studied population. This sample size was used for the retrospective cohort study, which aimed to develop a predictive model for postpartum depression (PPD) using electronic health records (EHRs) and machine learning algorithms

Age Range: The study did not explicitly mention the specific age range of the participants. However, it provided the mean age of the participants in the non-PPD group as 33.92 years with a standard deviation of 4.51, and in the PPD group as 34.36 years with a standard deviation of 4.61. This suggests that the participants were generally in their early to mid-thirties.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support PATIENT_CONSUMER

Intervention Description: This paper describes the engagement index customised for the Milk Man app, a mobile app designed to engage fathers with breastfeeding and parenting information.

Intervention Results: While overall, partners of participants who installed Milk Man were less likely to have ceased exclusive breastfeeding at any time point from birth to six weeks postpartum, this result was modest and of borderline significance (log rank test p = 0.052; Breslow p = 0.046; Tarone-Ware p = 0.049). The mean engagement score was 29.7% (range 1–80%), median 27.6%. Engagement level had no impact on duration of exclusive breastfeeding and demographic factors were not associated with engagement level.

Conclusion: This research demonstrates a range of metrics that can be used to quantify participant engagement. However, more research is needed to identify ways of measuring effective engagement.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Educational Materials Other Education Technology-Based Support COMMUNITY Social Media, Social Supports

Intervention Description: Many women do not have adequate and consistent social support to help them deal with breastfeeding difficulties at home after childbirth. Millennial women (those born between 1980 and 1999) have a significant presence online, making internet-based sources of breastfeeding support a potentially far-reaching, cost-effective, and convenient innovation. Social media platforms (e.g., Facebook, YouTube, Twitter, LinkedIn, Pinterest, GooglePlus+, Tumblr, and Instagram) are internet-based applications that enable the creation and exchange of user-generated content that may provide an avenue of social support. Social media breastfeeding support groups (SMBSGs) provide a cost-efficient, immediate approach to gaining social support and education from vast populations with various sociodemographics. Using 17 SMBSGs, the study team explored the variables that lead to sustained, exclusive breastfeeding to 6 months for breastfeeding millennial women who follow SMBSGs.

Intervention Results: Using structural equation modeling, I examined relationships among personal factors; competing situational demands; social support; and confidence in, knowledge of, attitude toward, and sustainability of breastfeeding. Age, education, and competing work and family demands were all predictive of social support. Breastfeeding social support had a direct effect on participants’ breastfeeding confidence, knowledge, and attitudes (F = 4.96, R2 = .07, p < .002). Furthermore, within SMBSGs, exclusive breastfeeding to 6 months was reported to be three times (66%) greater than the U.S. national average (22%).

Conclusion: Interventions aimed at providing women with resources to gain breastfeeding social support, such as SMBSGs, may be vehicles to improve women’s confidence, knowledge, and attitudes and, therefore, increase the potential for exclusive breastfeeding to 6 months.

Study Design: Repeated measures, longitudinal, mixed-methods

Setting: Online social media support groups across 21 countries

Population of Focus: Convenience sample of exclusively breastfeeding millenial women who followed at least one of 17 social media breastfeeding support groups

Sample Size: 241 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material Technology-Based Support PATIENT_CONSUMER

Intervention Description: In response to the cessation of in-person prenatal education services during the COVID-19 pandemic, we adapted an evidence-based curriculum to a live virtual format entitled Ready, Set, Baby Live COVID-19 Edition (RSB Live).

Intervention Results: In a sample of 146 pregnant people, participation in RSB Live was associated with high levels of knowledge about the benefits of breastfeeding, early infant hunger cues, and recommended maternity care practices, as well as high levels of satisfaction with adaptations to the session’s content and virtual delivery. Participation was also associated with a significant increase in prenatal breastfeeding intention, a known predictor of breastfeeding outcomes.

Conclusion: This study supports live, virtual education with a standardized curriculum as an effective and acceptable means of providing prenatal education.